Healthcare Provider Details

I. General information

NPI: 1366633851
Provider Name (Legal Business Name): DANIEL LOPEZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S BELLAIRE ST STE 185
DENVER CO
80222-4400
US

IV. Provider business mailing address

1777 S BELLAIRE ST STE 185
DENVER CO
80222-4400
US

V. Phone/Fax

Practice location:
  • Phone: 303-284-8592
  • Fax: 720-647-7318
Mailing address:
  • Phone: 303-284-8592
  • Fax: 720-647-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number258525
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDR.0057282
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: