Provider Demographics
NPI:1285045187
Name:CHERRY CREEK SPINE & SPORT CLINIC, LLC
Entity Type:Organization
Organization Name:CHERRY CREEK SPINE & SPORT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEIL-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-974-0392
Mailing Address - Street 1:400 S COLORADO BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1253
Mailing Address - Country:US
Mailing Address - Phone:720-974-0392
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1253
Practice Address - Country:US
Practice Address - Phone:720-974-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5762111NS0005X
CO6065111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922265909OtherNPI
CO1083651624OtherNPI