Provider Demographics
NPI:1790874196
Name:MOTT, PRINCESS PAIGE (DC)
Entity Type:Individual
Prefix:DR
First Name:PRINCESS
Middle Name:PAIGE
Last Name:MOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 GINNALA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2744
Mailing Address - Country:US
Mailing Address - Phone:970-622-0075
Mailing Address - Fax:970-663-0679
Practice Address - Street 1:2956 GINNALA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2744
Practice Address - Country:US
Practice Address - Phone:970-622-0075
Practice Address - Fax:970-663-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO5317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor