Provider Demographics
NPI:1346244712
Name:SORBO, ERIK RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:RAYMOND
Last Name:SORBO
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 1:1713 61ST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3047
Mailing Address - Country:US
Mailing Address - Phone:970-356-5255
Mailing Address - Fax:970-356-5880
Practice Address - Street 1:1713 61ST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3047
Practice Address - Country:US
Practice Address - Phone:970-356-5255
Practice Address - Fax:970-356-5880
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800760Medicare ID - Type Unspecified
COV03487Medicare UPIN