Provider Demographics
NPI:1154429637
Name:O'GRADY, BERNARD MICHAEL (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MICHAEL
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6315
Mailing Address - Country:US
Mailing Address - Phone:303-795-3668
Mailing Address - Fax:303-795-3669
Practice Address - Street 1:5020 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6315
Practice Address - Country:US
Practice Address - Phone:303-795-3668
Practice Address - Fax:303-795-3669
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1555111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14293Medicare UPIN