Provider Demographics
NPI:1326372095
Name:NEUROPHYSIOLOGIC, INC.
Entity Type:Organization
Organization Name:NEUROPHYSIOLOGIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLES
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:303-880-1429
Mailing Address - Street 1:1651 QUEBEC ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1963
Mailing Address - Country:US
Mailing Address - Phone:303-880-1429
Mailing Address - Fax:303-993-8955
Practice Address - Street 1:1651 QUEBEC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1963
Practice Address - Country:US
Practice Address - Phone:303-880-1429
Practice Address - Fax:303-993-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory