Provider Demographics
NPI:1053336453
Name:BORGES, DAVID (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BORGES
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 1:2074 LAKE TAHOE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6408
Mailing Address - Country:US
Mailing Address - Phone:530-544-5800
Mailing Address - Fax:530-544-5802
Practice Address - Street 1:2074 LAKE TAHOE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6408
Practice Address - Country:US
Practice Address - Phone:530-544-5800
Practice Address - Fax:530-544-5802
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0139430OtherBLUE CROSS PIN
CADC0139430OtherBLUE CROSS PIN
CAZZZ23104ZMedicare ID - Type Unspecified