Provider Demographics
NPI:1033526389
Name:DENVER SPORT & SPINE, LLC
Entity Type:Organization
Organization Name:DENVER SPORT & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GRIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-634-2975
Mailing Address - Street 1:3900 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2203
Mailing Address - Country:US
Mailing Address - Phone:303-634-2975
Mailing Address - Fax:303-634-2976
Practice Address - Street 1:3900 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2203
Practice Address - Country:US
Practice Address - Phone:303-634-2975
Practice Address - Fax:303-634-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0005662111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty