Provider Demographics
NPI:1396810784
Name:GOLMAN, CODY (DC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:GOLMAN
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 1:100 S MADISON ST
Mailing Address - Street 2:1A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3026
Mailing Address - Country:US
Mailing Address - Phone:303-399-3569
Mailing Address - Fax:303-399-1977
Practice Address - Street 1:100 S MADISON ST
Practice Address - Street 2:1A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3026
Practice Address - Country:US
Practice Address - Phone:303-399-3569
Practice Address - Fax:303-399-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV05871Medicare UPIN
CO802504Medicare ID - Type UnspecifiedINDIVIDUAL
CO802503Medicare ID - Type UnspecifiedGROUP