Healthcare Provider Details

I. General information

NPI: 1104986819
Provider Name (Legal Business Name): CHRISTIAN BLAKE BAILEY C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S COLORADO BLVD SUITE #220
DENVER CO
80246-8008
US

IV. Provider business mailing address

695 S COLORADO BLVD SUITE #220
DENVER CO
80246-8008
US

V. Phone/Fax

Practice location:
  • Phone: 303-346-1906
  • Fax: 303-962-1820
Mailing address:
  • Phone: 303-346-1906
  • Fax: 303-962-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO1908
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO1908
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: