Provider Demographics
NPI:1275663296
Name:BACH, KARRIE A (RD)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:A
Last Name:BACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KARRIE
Other - Middle Name:A
Other - Last Name:MARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:345 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3972
Mailing Address - Country:US
Mailing Address - Phone:303-544-5777
Mailing Address - Fax:303-544-5775
Practice Address - Street 1:311 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3979
Practice Address - Country:US
Practice Address - Phone:303-544-5700
Practice Address - Fax:303-544-5710
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO863726133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807685Medicare PIN