Healthcare Provider Details

I. General information

NPI: 1962827394
Provider Name (Legal Business Name): PROGRESSIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E HAMPDEN AVE STE 225
ENGLEWOOD CO
80113-2737
US

IV. Provider business mailing address

701 E HAMPDEN AVE STE 225
ENGLEWOOD CO
80113-2737
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-9399
  • Fax:
Mailing address:
  • Phone: 303-788-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0006328
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberEL.2775162
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0000851
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT.0010822
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT.0004234
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT.0005004
License Number StateCO

VIII. Authorized Official

Name: DOMINIQUE BRAVO
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 303-788-8388