Provider Demographics
NPI:1952365801
Name:CHAGALA, DAVID THOMAS (OMD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:CHAGALA
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0757
Mailing Address - Country:US
Mailing Address - Phone:303-442-3352
Mailing Address - Fax:
Practice Address - Street 1:762 COTTAGE LN
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0757
Practice Address - Country:US
Practice Address - Phone:303-442-3352
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist