Provider Demographics
NPI:1326379629
Name:COLORADO CENTER FOR SPINE MEDICINE LLC
Entity Type:Organization
Organization Name:COLORADO CENTER FOR SPINE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:ARENDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-444-2955
Mailing Address - Street 1:1155 ALPINE AVE
Mailing Address - Street 2:STE. 280
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3495
Mailing Address - Country:US
Mailing Address - Phone:303-444-2955
Mailing Address - Fax:303-546-6500
Practice Address - Street 1:1155 ALPINE AVE
Practice Address - Street 2:STE. 280
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3495
Practice Address - Country:US
Practice Address - Phone:303-444-2955
Practice Address - Fax:303-546-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42014208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty