Provider Demographics
NPI:1235124439
Name:HAITZ, GREGORY C (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:HAITZ
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 1:1133 PATTERSON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8854
Mailing Address - Country:US
Mailing Address - Phone:970-243-1388
Mailing Address - Fax:970-243-1572
Practice Address - Street 1:1133 PATTERSON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8854
Practice Address - Country:US
Practice Address - Phone:970-243-1388
Practice Address - Fax:970-243-1572
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98956Medicare UPIN
CO528448Medicare ID - Type Unspecified