Healthcare Provider Details

I. General information

NPI: 1477885895
Provider Name (Legal Business Name): HEALTHY Z OSTEOPATHIC FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S BROADWAY ST. SUITE 100
BOULDER CO
80305-3304
US

IV. Provider business mailing address

2910 STANFORD AVE
BOULDER CO
80305-5341
US

V. Phone/Fax

Practice location:
  • Phone: 720-259-4609
  • Fax:
Mailing address:
  • Phone: 720-259-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier27625737
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: DR. ERIC VANZURA
Title or Position: PHYSICIAN MEMBER
Credential: DO
Phone: 720-259-4609