Healthcare Provider Details

I. General information

NPI: 1528619186
Provider Name (Legal Business Name): SEAN MITCHELL ZIEMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 OSAGE ST
DENVER CO
80211-2656
US

IV. Provider business mailing address

3801 OSAGE ST
DENVER CO
80211-2656
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-5994
  • Fax:
Mailing address:
  • Phone: 219-730-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0008080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: