Provider Demographics
NPI:1790838373
Name:NYGAARD, DAVID P (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:NYGAARD
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 1:102 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1502
Mailing Address - Country:US
Mailing Address - Phone:970-854-2380
Mailing Address - Fax:
Practice Address - Street 1:102 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1502
Practice Address - Country:US
Practice Address - Phone:970-854-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC27523Medicare PIN