Provider Demographics
NPI:1356863120
Name:PEAK VITALITY LLC.
Entity Type:Organization
Organization Name:PEAK VITALITY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-504-8007
Mailing Address - Street 1:1536 COLE BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3413
Mailing Address - Country:US
Mailing Address - Phone:720-504-8007
Mailing Address - Fax:557-590-7418
Practice Address - Street 1:1536 COLE BLVD STE 335
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3413
Practice Address - Country:US
Practice Address - Phone:720-504-8007
Practice Address - Fax:557-590-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1639790163W00000X
COACU.0001814171100000X
CODR34457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1205202272Medicaid