Healthcare Provider Details

I. General information

NPI: 1245139302
Provider Name (Legal Business Name): JACK BRANEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6468 DEVINNEY ST
ARVADA CO
80004-2068
US

IV. Provider business mailing address

6468 DEVINNEY ST
ARVADA CO
80004-2068
US

V. Phone/Fax

Practice location:
  • Phone: 303-913-4521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: