Provider Demographics
NPI:1447336268
Name:GAPPA, JEFFREY R (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:GAPPA
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 1:606 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3202
Mailing Address - Country:US
Mailing Address - Phone:303-659-0805
Mailing Address - Fax:303-659-2676
Practice Address - Street 1:606 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3202
Practice Address - Country:US
Practice Address - Phone:303-659-0805
Practice Address - Fax:303-659-2676
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3285111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM12340OtherWORKERS COMPENSATION
CO47243Medicare ID - Type UnspecifiedMEDICARE PART B
COM12340OtherWORKERS COMPENSATION