Provider Demographics
NPI:1306387410
Name:BELLEVIEW SPINE AND WELLNESS PC
Entity Type:Organization
Organization Name:BELLEVIEW SPINE AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-771-3102
Mailing Address - Street 1:5191 S YOSEMITE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3305
Mailing Address - Country:US
Mailing Address - Phone:303-771-3102
Mailing Address - Fax:
Practice Address - Street 1:5191 S YOSEMITE ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3305
Practice Address - Country:US
Practice Address - Phone:303-771-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO49380208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty