Provider Demographics
NPI:1285622027
Name:DURANSO, DONALD E (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:DURANSO
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 1:5265 N ACADEMY BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4042
Mailing Address - Country:US
Mailing Address - Phone:719-597-7553
Mailing Address - Fax:719-597-7554
Practice Address - Street 1:5265 N ACADEMY BLVD
Practice Address - Street 2:STE 1100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4042
Practice Address - Country:US
Practice Address - Phone:719-597-7553
Practice Address - Fax:719-597-7554
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3903111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM36049OtherWORK COMP
CO84-1271572OtherEIN
COM36049OtherWORK COMP
COC29013Medicare PIN
CO45-3683883OtherEIN