Provider Demographics
NPI:1184738064
Name:GUBNITSKY, MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GUBNITSKY
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 1:945 S FEDERAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3586
Mailing Address - Country:US
Mailing Address - Phone:303-922-8146
Mailing Address - Fax:303-922-0158
Practice Address - Street 1:945 S FEDERAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-3586
Practice Address - Country:US
Practice Address - Phone:303-922-8146
Practice Address - Fax:303-922-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4498111N00000X
TX9940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809882Medicare PIN