Provider Demographics
NPI:1649716242
Name:DENVER SPORTS DOC, LLC
Entity type:Organization
Organization Name:DENVER SPORTS DOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-994-0301
Mailing Address - Street 1:12327 ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3421
Mailing Address - Country:US
Mailing Address - Phone:303-994-0301
Mailing Address - Fax:720-634-1131
Practice Address - Street 1:3993 ELATI ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4832
Practice Address - Country:US
Practice Address - Phone:303-994-0301
Practice Address - Fax:720-634-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty