Healthcare Provider Details

I. General information

NPI: 1073163671
Provider Name (Legal Business Name): BRET BOSTOCK CO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4582 S ULSTER ST STE 205
DENVER CO
80237-3011
US

IV. Provider business mailing address

4582 S ULSTER ST STE 205
DENVER CO
80237-3011
US

V. Phone/Fax

Practice location:
  • Phone: 720-475-1826
  • Fax:
Mailing address:
  • Phone: 602-919-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: