Provider Demographics
NPI:1922129964
Name:BORMAN, ROBERT D (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:BORMAN
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 1:1873 S BELLAIRE ST STE 1220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4359
Mailing Address - Country:US
Mailing Address - Phone:303-759-8514
Mailing Address - Fax:303-759-1813
Practice Address - Street 1:1873 S BELLAIRE ST STE 1220
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4359
Practice Address - Country:US
Practice Address - Phone:303-759-8514
Practice Address - Fax:303-759-1813
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC-10453Medicare ID - Type Unspecified