Provider Demographics
NPI:1932579349
Name:BRANFORT, JORDAN ARMEL
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ARMEL
Last Name:BRANFORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11185 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5538
Mailing Address - Country:US
Mailing Address - Phone:303-230-6060
Mailing Address - Fax:
Practice Address - Street 1:11185 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5538
Practice Address - Country:US
Practice Address - Phone:303-230-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004416261QX0100X
KS17-03170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine