Provider Demographics
NPI:1083000996
Name:LAKEWOOD INJURY TREATMENT CENTER INC
Entity Type:Organization
Organization Name:LAKEWOOD INJURY TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-330-0024
Mailing Address - Street 1:2 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8068
Mailing Address - Country:US
Mailing Address - Phone:303-734-7142
Mailing Address - Fax:303-734-7190
Practice Address - Street 1:605 PARFET ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5576
Practice Address - Country:US
Practice Address - Phone:303-330-0024
Practice Address - Fax:303-232-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0027638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty