Provider Demographics
NPI:1891934071
Name:TRICK, ANNETTE JO (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:JO
Last Name:TRICK
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 14TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5100
Mailing Address - Country:US
Mailing Address - Phone:970-422-8026
Mailing Address - Fax:
Practice Address - Street 1:128 W 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5100
Practice Address - Country:US
Practice Address - Phone:970-422-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2615-012111NS0005X
MT1173111NS0005X
CO6369111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician