Healthcare Provider Details

I. General information

NPI: 1386889640
Provider Name (Legal Business Name): THE GRATEFUL SPINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD STE 300
GLENDALE CO
80246-1253
US

IV. Provider business mailing address

400 S COLORADO BLVD STE 300
GLENDALE CO
80246-1253
US

V. Phone/Fax

Practice location:
  • Phone: 303-759-5575
  • Fax: 303-759-5589
Mailing address:
  • Phone: 303-759-5575
  • Fax: 303-759-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5844
License Number StateCO

VIII. Authorized Official

Name: DR. JASON ALBERT MARKIJOHN
Title or Position: OWNER/PRESIDENT
Credential: D.C
Phone: 303-759-5575