Provider Demographics
NPI:1205368552
Name:NEUROPATHY CENTER OF BOULDER COUNTY, LLC
Entity Type:Organization
Organization Name:NEUROPATHY CENTER OF BOULDER COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACHIMIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-666-1465
Mailing Address - Street 1:864 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2410
Mailing Address - Country:US
Mailing Address - Phone:720-242-9844
Mailing Address - Fax:
Practice Address - Street 1:864 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2410
Practice Address - Country:US
Practice Address - Phone:720-242-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER COUNTY FOOT & ANKLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1043227390Medicare UPIN