Healthcare Provider Details

I. General information

NPI: 1790694198
Provider Name (Legal Business Name): SECOND WIND WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7184 S SHADY GROVE CT
AURORA CO
80016-7562
US

IV. Provider business mailing address

7184 S SHADY GROVE CT
AURORA CO
80016-7562
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-0573
  • Fax:
Mailing address:
  • Phone: 303-763-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM DIESI
Title or Position: CO-OWNER/PROVIDER
Credential: NP
Phone: 303-763-0573