Provider Demographics
NPI:1639353188
Name:SUNSHINE WHOLISTIC SERVICES LLC
Entity Type:Organization
Organization Name:SUNSHINE WHOLISTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-449-3100
Mailing Address - Street 1:805 S BROADWAY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5971
Mailing Address - Country:US
Mailing Address - Phone:303-449-3100
Mailing Address - Fax:
Practice Address - Street 1:805 S BROADWAY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5971
Practice Address - Country:US
Practice Address - Phone:303-449-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M0728OtherMAIN MEDICARE #
M0728OtherMAIN MEDICARE #