Provider Demographics
NPI:1194839803
Name:COBERLY, GUY (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:COBERLY
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 TAFT AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8310
Mailing Address - Country:US
Mailing Address - Phone:970-203-0621
Mailing Address - Fax:
Practice Address - Street 1:3025 TAFT AVE STE A
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8310
Practice Address - Country:US
Practice Address - Phone:970-203-0621
Practice Address - Fax:970-461-2462
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44093Medicare ID - Type Unspecified