Healthcare Provider Details

I. General information

NPI: 1124225800
Provider Name (Legal Business Name): NORTH COLORADO SPINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W 9TH ST UNIT 1B
GREELEY CO
80634-4462
US

IV. Provider business mailing address

1624 17TH AVE
GREELEY CO
80631-5129
US

V. Phone/Fax

Practice location:
  • Phone: 970-353-5959
  • Fax: 970-353-5967
Mailing address:
  • Phone: 970-353-5959
  • Fax: 970-353-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT DHUPAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-353-5959