Healthcare Provider Details

I. General information

NPI: 1750139176
Provider Name (Legal Business Name): SILVER RUN COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 W MAIN STREET STE 102
LITTLETON CO
80120-8200
US

IV. Provider business mailing address

2329 W MAIN STREET STE 102
LITTLETON CO
80120-8200
US

V. Phone/Fax

Practice location:
  • Phone: 303-797-0988
  • Fax: 303-797-8011
Mailing address:
  • Phone: 303-797-0988
  • Fax: 303-797-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: HALEY S HARVEY
Title or Position: AUTHORIZED OFFICIAL
Credential: DC
Phone: 303-797-0988