Provider Demographics
NPI:1831166834
Name:COBERLY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:COBERLY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCEP
Authorized Official - Phone:970-203-0621
Mailing Address - Street 1:3780 N GARFIELD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2233
Mailing Address - Country:US
Mailing Address - Phone:970-203-0621
Mailing Address - Fax:
Practice Address - Street 1:3780 N GARFIELD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2233
Practice Address - Country:US
Practice Address - Phone:970-203-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44093Medicare ID - Type Unspecified