Healthcare Provider Details

I. General information

NPI: 1386897908
Provider Name (Legal Business Name): JUSTIN BLAKE DUKES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S COLORADO BLVD UNIT J
DENVER CO
80222-4011
US

IV. Provider business mailing address

1685 S COLORADO BLVD UNIT J
DENVER CO
80222-4011
US

V. Phone/Fax

Practice location:
  • Phone: 720-376-9037
  • Fax: 855-718-2754
Mailing address:
  • Phone: 720-376-9037
  • Fax: 855-718-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6255
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6255
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: