Healthcare Provider Details

I. General information

NPI: 1942708326
Provider Name (Legal Business Name): LUCKY BREAK ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W TOMICHI AVE STE B
GUNNISON CO
81230-2323
US

IV. Provider business mailing address

PO BOX 1627
CRESTED BUTTE CO
81224-1627
US

V. Phone/Fax

Practice location:
  • Phone: 970-672-1980
  • Fax: 970-817-2112
Mailing address:
  • Phone:
  • Fax:

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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number56343
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID HENRY ELFENBEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 970-672-1980