Active NPI
Glen Petcavage, D.C.
- Chiropractor
- Fort Collins, CO
National Provider Identifier
1982920435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHR-6164
- Practice address
- 1225 Redwood St
Fort Collins, CO 80524-2052 - Phone
- (970) 484-2023
- Fax
- (866) 867-8553
- NPI assigned
- Apr 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHR-6164 | CO | Primary |
Addresses
Primary practice location
1225 Redwood St
Fort Collins, CO 80524-2052
Mailing address
1225 Redwood St
Fort Collins, CO 80524-2052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHR-6164 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1982920435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 REDWOOD ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 REDWOOD ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242052",
"telephone_number": "970-484-2023",
"fax_number": "866-867-8553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETCAVAGE",
"first_name": "GLEN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CO",
"license": "CHR-6164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.