Provider Demographics
NPI:1568766319
Name:PEAK WELLNESS AND NUTRITION INC.
Entity Type:Organization
Organization Name:PEAK WELLNESS AND NUTRITION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:970-259-1712
Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-2207
Mailing Address - Country:US
Mailing Address - Phone:970-259-1712
Mailing Address - Fax:970-259-2466
Practice Address - Street 1:2855 MAIN AVE
Practice Address - Street 2:STE. 105A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5956
Practice Address - Country:US
Practice Address - Phone:970-259-1712
Practice Address - Fax:970-259-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO260007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center