Provider Demographics
NPI:1851489512
Name:KANNEGIETER, CURTIS RAY (DC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:RAY
Last Name:KANNEGIETER
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 1:6650 S VINE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2740
Mailing Address - Country:US
Mailing Address - Phone:303-730-3174
Mailing Address - Fax:303-795-3669
Practice Address - Street 1:6650 S VINE ST STE 110
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2740
Practice Address - Country:US
Practice Address - Phone:303-730-3174
Practice Address - Fax:303-730-2294
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17223Medicare ID - Type Unspecified
T60500Medicare UPIN