Provider Demographics
NPI:1518507938
Name:SOMERVILLE, CODY REED (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:REED
Last Name:SOMERVILLE
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 1:681 S ARBUTUS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3001
Mailing Address - Country:US
Mailing Address - Phone:304-482-5757
Mailing Address - Fax:
Practice Address - Street 1:9898 ROSEMONT AVE STE 204
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4107
Practice Address - Country:US
Practice Address - Phone:303-708-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor