Provider Demographics
NPI:1679578280
Name:OTTERSBERG, WILLIAM J JR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:OTTERSBERG
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3055 E HWY 50
Mailing Address - Street 2:SUITE C
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2775
Mailing Address - Country:US
Mailing Address - Phone:719-269-1020
Mailing Address - Fax:719-269-1021
Practice Address - Street 1:3055 E HWY 50
Practice Address - Street 2:SUITE C
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2775
Practice Address - Country:US
Practice Address - Phone:719-269-1020
Practice Address - Fax:719-269-1021
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC23963Medicare PIN