Provider Demographics
NPI:1497846059
Name:GINGRAS, RICHARD W (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:GINGRAS
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 1:8925 RIDGELINE BLVD
Mailing Address - Street 2:102
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2500
Mailing Address - Country:US
Mailing Address - Phone:303-791-4480
Mailing Address - Fax:
Practice Address - Street 1:8925 RIDGELINE BLVD
Practice Address - Street 2:102
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2354
Practice Address - Country:US
Practice Address - Phone:303-791-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46953Medicare ID - Type Unspecified