Healthcare Provider Details

I. General information

NPI: 1336413079
Provider Name (Legal Business Name): NICHOLAS LEVI JASON D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E ARAPAHOE RD STE 104
CENTENNIAL CO
80112-1390
US

IV. Provider business mailing address

3328 PAINT BRUSH LN
PARKER CO
80138-4240
US

V. Phone/Fax

Practice location:
  • Phone: 303-586-5999
  • Fax:
Mailing address:
  • Phone: 970-308-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6821
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: