Provider Demographics
NPI:1437550225
Name:ASPEN SPORTS MEDICINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ASPEN SPORTS MEDICINE INSTITUTE, LLC
Other - Org Name:ASPEN CLUB SPORTS MEDICINE INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-925-8900
Mailing Address - Street 1:1450 CRYSTAL LAKE RD
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2255
Mailing Address - Country:US
Mailing Address - Phone:970-925-8940
Mailing Address - Fax:970-925-9543
Practice Address - Street 1:1450 CRYSTAL LAKE RD
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2255
Practice Address - Country:US
Practice Address - Phone:970-925-8940
Practice Address - Fax:970-925-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty