Provider Demographics
NPI:1144797176
Name:LIMBROCK, DALE C (PA-C)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:C
Last Name:LIMBROCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5507
Mailing Address - Country:US
Mailing Address - Phone:719-433-5485
Mailing Address - Fax:
Practice Address - Street 1:3D MEDICAL BATTALION
Practice Address - Street 2:UNIT 38445
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373-8445
Practice Address - Country:US
Practice Address - Phone:011-816-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant