Provider Demographics
NPI:1104914167
Name:ROCAFORT, SERGIO A (DC)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:A
Last Name:ROCAFORT
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 1:945 S FEDERAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3586
Mailing Address - Country:US
Mailing Address - Phone:303-922-8146
Mailing Address - Fax:303-922-0158
Practice Address - Street 1:945 S FEDERAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-3586
Practice Address - Country:US
Practice Address - Phone:303-922-8146
Practice Address - Fax:303-922-0158
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06918111N00000X
CO0006936111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0742619Medicaid
NE10025541100Medicaid
IAV11182Medicare UPIN
IA0742619Medicaid