Provider Demographics
NPI:1053498030
Name:KADI, SAM ELIAS II (DC)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:ELIAS
Last Name:KADI
Suffix:II
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 1:2220 S FRASER ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4507
Mailing Address - Country:US
Mailing Address - Phone:303-745-3222
Mailing Address - Fax:303-750-0579
Practice Address - Street 1:2220 S FRASER ST
Practice Address - Street 2:UNIT 3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4507
Practice Address - Country:US
Practice Address - Phone:303-745-3222
Practice Address - Fax:303-750-0579
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44763Medicare ID - Type Unspecified