Healthcare Provider Details

I. General information

NPI: 1902190531
Provider Name (Legal Business Name): HEADACHE PREVENTION AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 1ST AVE SUITE 205
BROOMFIELD CO
80020-2401
US

IV. Provider business mailing address

340 E 1ST AVE SUITE 205
BROOMFIELD CO
80020-2401
US

V. Phone/Fax

Practice location:
  • Phone: 303-439-7777
  • Fax: 303-469-9050
Mailing address:
  • Phone: 303-439-7777
  • Fax: 303-469-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number34882
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number34882
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number34882
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number34882
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number34882
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number34882
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number34882
License Number StateCO

VIII. Authorized Official

Name: DR. TONIA MARIE SABO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 303-439-7777