Provider Demographics
NPI:1174900187
Name:SPECTOX LABS LLC
Entity type:Organization
Organization Name:SPECTOX LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-515-7234
Mailing Address - Street 1:23016 LAKE FOREST DR
Mailing Address - Street 2:SUITE A-398
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1324
Mailing Address - Country:US
Mailing Address - Phone:303-515-7234
Mailing Address - Fax:
Practice Address - Street 1:10850 DOVER ST
Practice Address - Street 2:SUITE 900
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-2652
Practice Address - Country:US
Practice Address - Phone:303-515-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D2099282291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory