Provider Demographics
NPI:1932297819
Name:PORTENIER, KEVIN RALPH (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RALPH
Last Name:PORTENIER
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 1:10223 W MARLOWE PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1322
Mailing Address - Country:US
Mailing Address - Phone:303-933-7095
Mailing Address - Fax:
Practice Address - Street 1:5066 S WADSWORTH WAY
Practice Address - Street 2:SUITE #103
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1254
Practice Address - Country:US
Practice Address - Phone:303-972-0800
Practice Address - Fax:303-972-4132
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor