Provider Demographics
NPI:1033356225
Name:GRATACOS, OSVALDO (DC)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:GRATACOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 US HIGHWAY 287
Mailing Address - Street 2:STE 100
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7080
Mailing Address - Country:US
Mailing Address - Phone:787-718-8370
Mailing Address - Fax:
Practice Address - Street 1:1140 US HIGHWAY 287
Practice Address - Street 2:STE 100
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7080
Practice Address - Country:US
Practice Address - Phone:303-469-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR487111N00000X
CO6812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program