Provider Demographics
NPI:1104927318
Name:RETZER, DALE GORDON (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:GORDON
Last Name:RETZER
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 1:609 W LITTLETON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2368
Mailing Address - Country:US
Mailing Address - Phone:303-730-2414
Mailing Address - Fax:303-730-2504
Practice Address - Street 1:609 W LITTLETON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2368
Practice Address - Country:US
Practice Address - Phone:303-730-2414
Practice Address - Fax:303-730-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22803Medicare ID - Type Unspecified
T60658Medicare UPIN