Healthcare Provider Details

I. General information

NPI: 1619313236
Provider Name (Legal Business Name): OSTEOPATHIC INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BROADWAY SUITE 200
DENVER CO
80203-5937
US

IV. Provider business mailing address

70 BROADWAY SUITE 200
DENVER CO
80203-5937
US

V. Phone/Fax

Practice location:
  • Phone: 303-350-7990
  • Fax:
Mailing address:
  • Phone: 303-350-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number40470
License Number StateCO

VIII. Authorized Official

Name: DAVID ZAROU
Title or Position: PRESIDENT/OWNER
Credential: DO
Phone: 303-350-7990