Provider Demographics
NPI:1043370810
Name:GENGLER, KIRBY SHANE (DC)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:SHANE
Last Name:GENGLER
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 1:2135 COPLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3503
Mailing Address - Country:US
Mailing Address - Phone:719-233-8526
Mailing Address - Fax:
Practice Address - Street 1:3707 PARKMOOR VILLAGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-6251
Practice Address - Country:US
Practice Address - Phone:719-571-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6598111N00000X, 111N00000X
KY4489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1003001Medicare PIN
U73964Medicare UPIN
COCOA107395Medicare PIN
U73964Medicare UPIN
COCOA107395Medicare PIN