Provider Demographics
NPI:1417930306
Name:TREINEN, MICHAEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:TREINEN
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 1:1933 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3039
Mailing Address - Country:US
Mailing Address - Phone:970-565-4800
Mailing Address - Fax:970-565-0821
Practice Address - Street 1:1933 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3039
Practice Address - Country:US
Practice Address - Phone:970-565-4800
Practice Address - Fax:970-565-0821
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK5323Medicare PIN
COT60610Medicare UPIN