Healthcare Provider Details

I. General information

NPI: 1881946192
Provider Name (Legal Business Name): AXIS HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7790 E ARAPAHOE RD SUITE 102
CENTENNIAL CO
80112-1274
US

IV. Provider business mailing address

7790 E ARAPAHOE RD SUITE 102
CENTENNIAL CO
80112-1274
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-1185
  • Fax:
Mailing address:
  • Phone: 303-221-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TONY NICHOLAS
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 303-221-1185