Provider Demographics
NPI:1962827394
Name:PROGRESSIVE HEALTH CENTER
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-788-8388
Mailing Address - Street 1:701 E HAMPDEN AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2737
Mailing Address - Country:US
Mailing Address - Phone:303-788-9399
Mailing Address - Fax:
Practice Address - Street 1:701 E HAMPDEN AVE STE 225
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2737
Practice Address - Country:US
Practice Address - Phone:303-788-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006328111N00000X
COEL.2775162111N00000X
COACU.0000851171100000X
COMT.0010822171W00000X
COMT.0004234171W00000X
COMT.0005004171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty