Healthcare Provider Details

I. General information

NPI: 1124371570
Provider Name (Legal Business Name): DENVER SPORT AND SPINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 09/06/2023
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 TENNYSON ST
DENVER CO
80212-1723
US

IV. Provider business mailing address

3441 TENNYSON ST
DENVER CO
80212-1723
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-5994
  • Fax: 303-993-2681
Mailing address:
  • Phone: 303-955-5994
  • Fax: 303-993-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6656
License Number StateCO

VIII. Authorized Official

Name: JONATHAN ROBER RAGER WEIMER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 303-960-8016