Provider Demographics
NPI:1417975897
Name:BOVADILLA, GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOVADILLA
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 1:4045 WADSWORTH BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4626
Mailing Address - Country:US
Mailing Address - Phone:303-647-8136
Mailing Address - Fax:918-493-1773
Practice Address - Street 1:4045 WADSWORTH BLVD STE 307
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4626
Practice Address - Country:US
Practice Address - Phone:303-647-8136
Practice Address - Fax:918-770-8208
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAC.2786112171100000X
COCHR.0007121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist