Provider Demographics
NPI:1396118774
Name:4D SPINE
Entity type:Organization
Organization Name:4D SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-792-3320
Mailing Address - Street 1:6825 S GALENA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3715
Mailing Address - Country:US
Mailing Address - Phone:303-792-3320
Mailing Address - Fax:
Practice Address - Street 1:6825 S GALENA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3715
Practice Address - Country:US
Practice Address - Phone:303-792-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies