Provider Demographics
NPI:1467585935
Name:THEISEN, JOHN CHRISTOPHER (BA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:THEISEN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-7390
Mailing Address - Country:US
Mailing Address - Phone:303-659-9377
Mailing Address - Fax:
Practice Address - Street 1:1920 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2002
Practice Address - Country:US
Practice Address - Phone:303-321-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator