Provider Demographics
NPI:1174841464
Name:DENVER SPINE LLC
Entity type:Organization
Organization Name:DENVER SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELS
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-953-1471
Mailing Address - Street 1:1699 S COLORADO BLVD
Mailing Address - Street 2:UNIT M
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4036
Mailing Address - Country:US
Mailing Address - Phone:303-953-1471
Mailing Address - Fax:
Practice Address - Street 1:1699 S COLORADO BLVD
Practice Address - Street 2:UNIT M
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4036
Practice Address - Country:US
Practice Address - Phone:303-953-1471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6451111NP0017X
CO6453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty