Healthcare Provider Details

I. General information

NPI: 1932269420
Provider Name (Legal Business Name): CEO SOUTH DENVER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E MISSISSIPPI AVENUE SUITE 310
GLENDALE CO
80246
US

IV. Provider business mailing address

4100 E MISSISSIPPI AVENUE SUITE 310
GLENDALE CO
80246
US

V. Phone/Fax

Practice location:
  • Phone: 303-759-5575
  • Fax: 720-596-5171
Mailing address:
  • Phone: 303-759-5575
  • Fax: 720-596-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMES J HOVEN JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 303-759-5575