Provider Demographics
NPI:1265071641
Name:WAARA, NATHAN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JAMES
Last Name:WAARA
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 1:2740 ELIOT CIR APT 13
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5602
Mailing Address - Country:US
Mailing Address - Phone:585-456-3509
Mailing Address - Fax:
Practice Address - Street 1:1715 IRON HORSE DR STE 145
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9756
Practice Address - Country:US
Practice Address - Phone:585-456-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01332501111N00000X
COCHR.0008144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty