Healthcare Provider Details

I. General information

NPI: 1043762636
Provider Name (Legal Business Name): ACTION SPINE & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 10/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 LARIMER ST
DENVER CO
80205-2094
US

IV. Provider business mailing address

2209 LARIMER ST
DENVER CO
80205-2094
US

V. Phone/Fax

Practice location:
  • Phone: 720-541-7098
  • Fax: 720-278-7866
Mailing address:
  • Phone: 720-541-7098
  • Fax: 720-278-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0006855
License Number StateCO

VIII. Authorized Official

Name: DR. BENJAMIN R COWIN
Title or Position: OWNER
Credential: DC, MS, ATC
Phone: 720-541-7098