Provider Demographics
NPI:1417162975
Name:BIVRELL, PAUL FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANK
Last Name:BIVRELL
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-0412
Mailing Address - Country:US
Mailing Address - Phone:720-890-9800
Mailing Address - Fax:720-890-9801
Practice Address - Street 1:287 CENTURY CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1683
Practice Address - Country:US
Practice Address - Phone:720-890-9800
Practice Address - Fax:720-890-9801
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48053Medicare ID - Type Unspecified
COU65681Medicare UPIN