Provider Demographics
NPI:1376805325
Name:DRAPER, DAVID KENDALL
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KENDALL
Last Name:DRAPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 DECATUR ST
Mailing Address - Street 2:#211
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5182
Mailing Address - Country:US
Mailing Address - Phone:303-906-1523
Mailing Address - Fax:
Practice Address - Street 1:2195 DECATUR ST
Practice Address - Street 2:#211
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5182
Practice Address - Country:US
Practice Address - Phone:303-906-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist