Provider Demographics
NPI:1184836736
Name:DENVER OSTEOPATHIC CENTER DO PC
Entity Type:Organization
Organization Name:DENVER OSTEOPATHIC CENTER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-991-4651
Mailing Address - Street 1:10555 E DARTMOUTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2645
Mailing Address - Country:US
Mailing Address - Phone:303-991-4651
Mailing Address - Fax:303-991-3300
Practice Address - Street 1:10555 E DARTMOUTH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2645
Practice Address - Country:US
Practice Address - Phone:303-991-4651
Practice Address - Fax:303-991-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22411204D00000X
CO37895204D00000X
CO37896207QH0002X
CO2031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC500988Medicare PIN