Provider Demographics
NPI:1477110823
Name:DENVER OSTEOPATHIC AND SPORTS MEDICINE CENTER A PROFESSIONAL LLC
Entity Type:Organization
Organization Name:DENVER OSTEOPATHIC AND SPORTS MEDICINE CENTER A PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:COOPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-991-4651
Mailing Address - Street 1:10555 E DARTMOUTH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2673
Mailing Address - Country:US
Mailing Address - Phone:303-991-4651
Mailing Address - Fax:303-991-3300
Practice Address - Street 1:10555 E DARTMOUTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2673
Practice Address - Country:US
Practice Address - Phone:303-991-4651
Practice Address - Fax:303-991-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty