Healthcare Provider Details

I. General information

NPI: 1699512137
Provider Name (Legal Business Name): OPTIMAL SPINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 CENTER GREEN DR # 259
BOULDER CO
80301-2251
US

IV. Provider business mailing address

11181 E BERRY DR STE 50
ENGLEWOOD CO
80111-3908
US

V. Phone/Fax

Practice location:
  • Phone: 936-445-7625
  • Fax: 281-462-4106
Mailing address:
  • Phone: 303-886-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFF COTTON
Title or Position: CEO
Credential:
Phone: 303-886-0322