Provider Demographics
NPI:1457598971
Name:GALLERIA WELLNESS CENTER
Entity Type:Organization
Organization Name:GALLERIA WELLNESS CENTER
Other - Org Name:TIMOTHY CYMANSKI DC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-758-3395
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:162A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1904
Mailing Address - Country:US
Mailing Address - Phone:303-758-3395
Mailing Address - Fax:303-758-5140
Practice Address - Street 1:720 S COLORADO BLVD
Practice Address - Street 2:162A
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:303-758-3395
Practice Address - Fax:303-758-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5792261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU54395Medicare UPIN