Healthcare Provider Details

I. General information

NPI: 1962770842
Provider Name (Legal Business Name): BODY IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LEETSDALE DR SUITE 105
DENVER CO
80246-1438
US

IV. Provider business mailing address

5250 LEETSDALE DR SUITE 105
DENVER CO
80246-1438
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-1675
  • Fax: 303-333-0476
Mailing address:
  • Phone: 303-393-1675
  • Fax: 303-333-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6155
License Number StateCO

VIII. Authorized Official

Name: DR. JUSTIN DUKES
Title or Position: OWNER/ CHIROPRACTOR
Credential: DC
Phone: 303-393-1675