Healthcare Provider Details

I. General information

NPI: 1427152032
Provider Name (Legal Business Name): COLORADO SPRINGS OSTEOPATHIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4087
US

IV. Provider business mailing address

3480 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4087
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-2823
  • Fax: 719-635-4727
Mailing address:
  • Phone: 719-635-2823
  • Fax: 719-635-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDIA R. BEETHE
Title or Position: CLINIC MANAGER
Credential:
Phone: 719-635-2823