Provider Demographics
NPI:1033484597
Name:MASSAGE SPECIALIST
Entity Type:Organization
Organization Name:MASSAGE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-777-7874
Mailing Address - Street 1:70 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-5915
Mailing Address - Country:US
Mailing Address - Phone:303-777-7874
Mailing Address - Fax:303-962-9524
Practice Address - Street 1:70 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-5915
Practice Address - Country:US
Practice Address - Phone:303-777-7874
Practice Address - Fax:303-962-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty