Healthcare Provider Details

I. General information

NPI: 1760621148
Provider Name (Legal Business Name): SPINAL DISK DECOMPRESSION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 MCWHINNEY BLVD
LOVELAND CO
80538-8863
US

IV. Provider business mailing address

5285 MCWHINNEY BLVD
LOVELAND CO
80538-8863
US

V. Phone/Fax

Practice location:
  • Phone: 303-594-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE L HALES
Title or Position: BILLING MANAGER
Credential:
Phone: 303-594-3644