Provider Demographics
NPI:1740322239
Name:CENTER FOR HOLISTIC & INTEGRATIVE MEDICINE PROF LLC
Entity type:Organization
Organization Name:CENTER FOR HOLISTIC & INTEGRATIVE MEDICINE PROF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-690-9996
Mailing Address - Street 1:14991 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3986
Mailing Address - Country:US
Mailing Address - Phone:303-690-9996
Mailing Address - Fax:303-400-8450
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3986
Practice Address - Country:US
Practice Address - Phone:303-690-9996
Practice Address - Fax:303-400-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31535207Q00000X, 2083P0500X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty