Provider Demographics
NPI:1881698462
Name:GUEVARA, MARYBETH (DC)
Entity type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 BLUE MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4503
Mailing Address - Country:US
Mailing Address - Phone:719-684-7832
Mailing Address - Fax:
Practice Address - Street 1:3152 BLUE MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4503
Practice Address - Country:US
Practice Address - Phone:719-684-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU80372Medicare UPIN
CO801869Medicare ID - Type Unspecified