Healthcare Provider Details

I. General information

NPI: 1710534524
Provider Name (Legal Business Name): COLORADO KNEE AND SPINE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6726 S REVERE PKWY STE 180
CENTENNIAL CO
80112-3962
US

IV. Provider business mailing address

6726 S REVERE PKWY STE 180
CENTENNIAL CO
80112-3962
US

V. Phone/Fax

Practice location:
  • Phone: 720-681-6170
  • Fax:
Mailing address:
  • Phone: 720-681-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFF SELANO
Title or Position: OWNER/CEO
Credential: DC
Phone: 720-681-6170