Provider Demographics
NPI:1720106503
Name:HART, PAMELA L (DC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 N ORCHARD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5815
Mailing Address - Country:US
Mailing Address - Phone:303-527-2977
Mailing Address - Fax:
Practice Address - Street 1:5761 N ORCHARD CREEK CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5815
Practice Address - Country:US
Practice Address - Phone:303-527-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU31324Medicare UPIN
CO525288Medicare ID - Type UnspecifiedNAS MEDICARE PART B