Healthcare Provider Details

I. General information

NPI: 1235227174
Provider Name (Legal Business Name): TRI HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11275 EAST MISSISSIPPI AVENUE SUITE 2S2
AURORA CO
80012-3263
US

IV. Provider business mailing address

11275 EAST MISSISSIPPI AVENUE SUITE 2S2
AURORA CO
80012-3263
US

V. Phone/Fax

Practice location:
  • Phone: 720-859-9105
  • Fax: 720-859-9106
Mailing address:
  • Phone: 720-859-9105
  • Fax: 720-859-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5193
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHUNG JOON SEO
Title or Position: PRESIDENT
Credential: DC
Phone: 720-859-9105