Healthcare Provider Details

I. General information

NPI: 1598875007
Provider Name (Legal Business Name): PROACTIVE HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE SUITE 740S
DENVER CO
80220-3900
US

IV. Provider business mailing address

4500 E 9TH AVE SUITE 740S
DENVER CO
80220-3900
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-6530
  • Fax: 303-355-5035
Mailing address:
  • Phone: 303-320-6530
  • Fax: 303-355-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SHAPIRO
Title or Position: PHYSICIAN/OWNER
Credential: MD, PHD
Phone: 303-320-6530