Provider Demographics
NPI:1558552877
Name:DENVER HEADACHE AND SPINE CENTER PC
Entity Type:Organization
Organization Name:DENVER HEADACHE AND SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-795-7530
Mailing Address - Street 1:1501 W CAMPUS DR STE I
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4535
Mailing Address - Country:US
Mailing Address - Phone:303-795-7530
Mailing Address - Fax:303-795-7660
Practice Address - Street 1:1501 W CAMPUS DR STE I
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4535
Practice Address - Country:US
Practice Address - Phone:303-795-7530
Practice Address - Fax:303-795-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC522348Medicare PIN