Provider Demographics
NPI:1568565844
Name:BRIDGE, ROBERT EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:BRIDGE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:13762 COLORADO BLVD
Mailing Address - Street 2:#154
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-6919
Mailing Address - Country:US
Mailing Address - Phone:303-252-0202
Mailing Address - Fax:303-252-9500
Practice Address - Street 1:13762 COLORADO BLVD
Practice Address - Street 2:UNIT 122
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-6919
Practice Address - Country:US
Practice Address - Phone:303-252-0202
Practice Address - Fax:303-252-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2019-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO4665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48623Medicare ID - Type UnspecifiedCHIROPRACTIC