Provider Demographics
NPI:1902190531
Name:HEADACHE PREVENTION AND WELLNESS, PC
Entity Type:Organization
Organization Name:HEADACHE PREVENTION AND WELLNESS, PC
Other - Org Name:COLORADO PEDIATRIC NEUROLOGY AND HEADACHE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-439-7777
Mailing Address - Street 1:340 E 1ST AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2401
Mailing Address - Country:US
Mailing Address - Phone:303-439-7777
Mailing Address - Fax:303-469-9050
Practice Address - Street 1:340 E 1ST AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2401
Practice Address - Country:US
Practice Address - Phone:303-439-7777
Practice Address - Fax:303-469-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34882133NN1002X, 2251N0400X, 261QC1500X, 261QH0100X, 261QM1300X, 261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34882OtherBOULDER VALLEY IPA
CO1487739132OtherTONIA SABO, MD