Healthcare Provider Details

I. General information

NPI: 1164878021
Provider Name (Legal Business Name): ULTIMATE HEALTH MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 W LONG DR UNIT 12
LITTLETON CO
80123-1262
US

IV. Provider business mailing address

7735 W LONG DR UNIT 12
LITTLETON CO
80123-1262
US

V. Phone/Fax

Practice location:
  • Phone: 303-904-0331
  • Fax: 303-948-3153
Mailing address:
  • Phone: 303-904-0331
  • Fax: 303-948-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4690
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0174570
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0000394
License Number StateCO

VIII. Authorized Official

Name: JASON LEAVITT
Title or Position: OWNER
Credential: D.C.
Phone: 303-904-0331