Provider Demographics
NPI:1679840029
Name:DONALD G DRESSEN D C P C
Entity Type:Organization
Organization Name:DONALD G DRESSEN D C P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-544-5545
Mailing Address - Street 1:725 DESERT FLOWER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1268
Mailing Address - Country:US
Mailing Address - Phone:719-544-5545
Mailing Address - Fax:719-542-7437
Practice Address - Street 1:725 DESERT FLOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1268
Practice Address - Country:US
Practice Address - Phone:719-544-5545
Practice Address - Fax:719-542-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11573Medicare PIN
COU28957Medicare UPIN