Provider Demographics
NPI:1003204249
Name:DISCOVER HEALTH AND WELLNESS BROOMFIELD
Entity Type:Organization
Organization Name:DISCOVER HEALTH AND WELLNESS BROOMFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEPPEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LASZLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-708-5309
Mailing Address - Street 1:2095 W 6TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1870
Mailing Address - Country:US
Mailing Address - Phone:720-542-3748
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:720-542-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty