Healthcare Provider Details

I. General information

NPI: 1477110823
Provider Name (Legal Business Name): DENVER OSTEOPATHIC AND SPORTS MEDICINE CENTER A PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 E DARTMOUTH AVE STE 200
AURORA CO
80014-2673
US

IV. Provider business mailing address

10555 E DARTMOUTH AVE STE 200
AURORA CO
80014-2673
US

V. Phone/Fax

Practice location:
  • Phone: 303-991-4651
  • Fax: 303-991-3300
Mailing address:
  • Phone: 303-991-4651
  • Fax: 303-991-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL BRUCE COOPERMAN
Title or Position: OWNER
Credential: DO
Phone: 303-991-4651