Provider Demographics
NPI:1508030529
Name:BOULDER THERAPEUTICS, INC.
Entity Type:Organization
Organization Name:BOULDER THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR OF THERAPIES
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ABOOKIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:303-444-1171
Mailing Address - Street 1:1790 30TH ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1022
Mailing Address - Country:US
Mailing Address - Phone:303-444-1171
Mailing Address - Fax:303-258-7425
Practice Address - Street 1:1790 30TH ST
Practice Address - Street 2:SUITE #200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1022
Practice Address - Country:US
Practice Address - Phone:303-444-1171
Practice Address - Fax:303-258-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty