Provider Demographics
NPI:1932247103
Name:MOOBERRY, MARY KATHERINE RATZ (DC)
Entity Type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:RATZ
Last Name:MOOBERRY
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 1:30772 SOUTHVIEW DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2214
Mailing Address - Country:US
Mailing Address - Phone:303-670-7777
Mailing Address - Fax:303-482-1946
Practice Address - Street 1:30772 SOUTHVIEW DR STE 140
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2214
Practice Address - Country:US
Practice Address - Phone:303-670-7777
Practice Address - Fax:303-482-1946
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6029111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6029OtherCO CHIROPRACTIC LICENSE #