Provider Demographics
NPI:1023559531
Name:CHAMPLIN, BRADFORD (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:
Last Name:CHAMPLIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 E 2ND AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4248
Mailing Address - Country:US
Mailing Address - Phone:314-973-6663
Mailing Address - Fax:
Practice Address - Street 1:6535 S DAYTON ST STE 2200
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6257
Practice Address - Country:US
Practice Address - Phone:720-432-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0020298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist