Healthcare Provider Details

I. General information

NPI: 1285045187
Provider Name (Legal Business Name): CHERRY CREEK SPINE & SPORT CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD SUITE 300
DENVER CO
80246-1253
US

IV. Provider business mailing address

400 S COLORADO BLVD SUITE 300
DENVER CO
80246-1253
US

V. Phone/Fax

Practice location:
  • Phone: 720-974-0392
  • Fax:
Mailing address:
  • Phone: 720-974-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6065
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5762
License Number StateCO

VIII. Authorized Official

Name: DR. SCOTT M SHEIL-BROWN
Title or Position: CO-OWNER
Credential: DC
Phone: 720-974-0392