Provider Demographics
NPI:1174686612
Name:SPATAFORA, JOHN ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADAM
Last Name:SPATAFORA
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:PO BOX 55186
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-5010
Mailing Address - Country:US
Mailing Address - Phone:970-255-0777
Mailing Address - Fax:
Practice Address - Street 1:735 BOOKCLIFF AVE
Practice Address - Street 2:UNIT D
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8107
Practice Address - Country:US
Practice Address - Phone:970-255-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3695OtherCO STATE LICENSE
COC46633Medicare ID - Type Unspecified