Provider Demographics
NPI:1124371570
Name:DENVER SPORT AND SPINE INC
Entity Type:Organization
Organization Name:DENVER SPORT AND SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ROBER RAGER
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-960-8016
Mailing Address - Street 1:3441 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1723
Mailing Address - Country:US
Mailing Address - Phone:303-955-5994
Mailing Address - Fax:303-993-2681
Practice Address - Street 1:3441 TENNYSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-1723
Practice Address - Country:US
Practice Address - Phone:303-955-5994
Practice Address - Fax:303-993-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6656111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty