Provider Demographics
NPI:1629007190
Name:KLEKER, MICHAEL OTTO (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OTTO
Last Name:KLEKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 ZENDT DR
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6216
Mailing Address - Country:US
Mailing Address - Phone:970-493-7016
Mailing Address - Fax:
Practice Address - Street 1:2601 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2247
Practice Address - Country:US
Practice Address - Phone:970-223-4422
Practice Address - Fax:970-223-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC14123Medicare PIN
COT60484Medicare UPIN