Provider Demographics
NPI:1639406127
Name:GOTTSCHE, BENJAMIN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:GOTTSCHE
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 1:12330 W 58TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1243
Mailing Address - Country:US
Mailing Address - Phone:303-420-4270
Mailing Address - Fax:303-420-3490
Practice Address - Street 1:12330 W 58TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1243
Practice Address - Country:US
Practice Address - Phone:303-420-4270
Practice Address - Fax:303-420-3490
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6429111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO41358Medicare PIN
COCOB5020Medicare PIN