Provider Demographics
NPI:1861900227
Name:FRONT RANGE SPINE AND JOINT, LLC
Entity type:Organization
Organization Name:FRONT RANGE SPINE AND JOINT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-514-1347
Mailing Address - Street 1:PO BOX 21037
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7021
Mailing Address - Country:US
Mailing Address - Phone:307-220-1347
Mailing Address - Fax:
Practice Address - Street 1:514 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4646
Practice Address - Country:US
Practice Address - Phone:307-514-1347
Practice Address - Fax:307-514-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center