Healthcare Provider Details

I. General information

NPI: 1518364975
Provider Name (Legal Business Name): 5280 BALANCED HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5690 DTC BLVD SUITE 140E
GREENWOOD VILLAGE CO
80111-3232
US

IV. Provider business mailing address

5690 DTC BLVD SUITE 140E
GREENWOOD VILLAGE CO
80111-3232
US

V. Phone/Fax

Practice location:
  • Phone: 303-915-7997
  • Fax:
Mailing address:
  • Phone: 303-915-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0006640
License Number StateCO

VIII. Authorized Official

Name: KATHRYN MAE DECKER
Title or Position: OWNER
Credential: DC
Phone: 303-915-7997