Provider Demographics
NPI:1073569505
Name:ENEBO, BRIAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLEN
Last Name:ENEBO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 6503
Mailing Address - Street 2:INTEGRATIVE MEDICINE PROGRAM UCH
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-0503
Mailing Address - Country:US
Mailing Address - Phone:303-724-5000
Mailing Address - Fax:303-724-5816
Practice Address - Street 1:1635 URSULA ST
Practice Address - Street 2:SUITE #5501
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-7402
Practice Address - Country:US
Practice Address - Phone:720-848-1090
Practice Address - Fax:720-848-1277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO4445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV04968Medicare UPIN