Provider Demographics
NPI:1649657933
Name:MILE HIGH SPINE AND PAIN CLINIC INC.
Entity type:Organization
Organization Name:MILE HIGH SPINE AND PAIN CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE HYEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:720-401-8156
Mailing Address - Street 1:7940 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-5104
Mailing Address - Country:US
Mailing Address - Phone:303-927-6181
Mailing Address - Fax:720-379-5827
Practice Address - Street 1:7940 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-5104
Practice Address - Country:US
Practice Address - Phone:303-927-6181
Practice Address - Fax:720-379-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR,0026309207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty