Healthcare Provider Details

I. General information

NPI: 1104094119
Provider Name (Legal Business Name): ASPEN DIAGNOSTICS & DECOMPRESSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24505 HIGHWAY 82
BASALT CO
81621-9204
US

IV. Provider business mailing address

1517 BLAKE AVE SUITE 203
GLENWOOD SPRINGS CO
81601-3643
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-4450
  • Fax: 970-947-9916
Mailing address:
  • Phone: 970-384-4450
  • Fax: 970-947-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID SCOTT JENSEN
Title or Position: OWNER
Credential: D.C.
Phone: 970-384-4450