Provider Demographics
NPI:1225249543
Name:KLEINSORGE, MARY (D C)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:KLEINSORGE
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 1650 LN
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-8107
Mailing Address - Country:US
Mailing Address - Phone:970-874-4547
Mailing Address - Fax:970-236-9633
Practice Address - Street 1:885 1650 LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-8107
Practice Address - Country:US
Practice Address - Phone:970-874-4547
Practice Address - Fax:970-797-1246
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22793Medicare ID - Type Unspecified