Healthcare Provider Details

I. General information

NPI: 1679923718
Provider Name (Legal Business Name): COLORADO BACK INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 PARK MEADOWS BLVD STE 150
LONE TREE CO
80124-8401
US

IV. Provider business mailing address

10535 PARK MEADOWS BLVD STE 150
LONE TREE CO
80124-8401
US

V. Phone/Fax

Practice location:
  • Phone: 303-594-2686
  • Fax: 877-569-2398
Mailing address:
  • Phone: 303-594-2686
  • Fax: 877-569-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA M DOUGLAS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 720-441-4021