Provider Demographics
NPI:1033463385
Name:TORI, MICHELLE (CDR)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:TORI
Suffix:
Gender:F
Credentials:CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-763-4900
Mailing Address - Fax:
Practice Address - Street 1:1707 COLE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3220
Practice Address - Country:US
Practice Address - Phone:303-763-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO724685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered