Healthcare Provider Details

I. General information

NPI: 1710360011
Provider Name (Legal Business Name): SUNSTONE HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2015
Last Update Date: 07/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST STE H101
FORT COLLINS CO
80526-1827
US

IV. Provider business mailing address

2001 S SHIELDS ST STE H101
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-1000
  • Fax:
Mailing address:
  • Phone: 970-494-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0007158
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002023
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0008810
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0017762
License Number StateCO

VIII. Authorized Official

Name: DR. KELVIN DAVES WITT
Title or Position: OWNER
Credential: D.C.
Phone: 970-494-1000