Provider Demographics
NPI:1023627684
Name:PLASTICITY CENTERS OF COLORADO LLC
Entity type:Organization
Organization Name:PLASTICITY CENTERS OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-912-2212
Mailing Address - Street 1:991 SOUTHPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5689
Mailing Address - Country:US
Mailing Address - Phone:720-912-2212
Mailing Address - Fax:720-912-2212
Practice Address - Street 1:991 SOUTHPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5689
Practice Address - Country:US
Practice Address - Phone:720-912-2212
Practice Address - Fax:720-912-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty