Provider Demographics
NPI:1164878021
Name:ULTIMATE HEALTH MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:ULTIMATE HEALTH MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-904-0331
Mailing Address - Street 1:7735 W LONG DR UNIT 12
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1262
Mailing Address - Country:US
Mailing Address - Phone:303-904-0331
Mailing Address - Fax:303-948-3153
Practice Address - Street 1:7735 W LONG DR UNIT 12
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1262
Practice Address - Country:US
Practice Address - Phone:303-904-0331
Practice Address - Fax:303-948-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4690111N00000X
CO0174570363L00000X
CO0000394363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherTAX ID NUMBER