Provider Demographics
NPI:1093859308
Name:PEDERSON, NANCY (DC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20128 E DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-8434
Mailing Address - Country:US
Mailing Address - Phone:303-221-3600
Mailing Address - Fax:720-529-0222
Practice Address - Street 1:6881 S HOLLY CIRCLE
Practice Address - Street 2:SUITE 207
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1145
Practice Address - Country:US
Practice Address - Phone:303-221-3600
Practice Address - Fax:720-529-0222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO482328Medicare ID - Type UnspecifiedPC MEDICARE
CO482318Medicare ID - Type UnspecifiedDR. PEDERSON