Provider Demographics
NPI:1083201198
Name:COLORADO INTEGRATIVE WELLNESS LLC
Entity Type:Organization
Organization Name:COLORADO INTEGRATIVE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-862-8061
Mailing Address - Street 1:1175 S PERRY ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0017
Mailing Address - Country:US
Mailing Address - Phone:303-862-8061
Mailing Address - Fax:720-676-1411
Practice Address - Street 1:1175 S PERRY ST STE 250
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-0017
Practice Address - Country:US
Practice Address - Phone:303-862-8061
Practice Address - Fax:720-676-1411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO INTEGRATIVE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84625562Medicaid