Healthcare Provider Details

I. General information

NPI: 1366028680
Provider Name (Legal Business Name): SWEET FEET PODIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 09/06/2023
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 MCLAUGHLIN RD STE G
PEYTON CO
80831-4719
US

IV. Provider business mailing address

7376 MCLAUGHLIN RD STE G
PEYTON CO
80831-4719
US

V. Phone/Fax

Practice location:
  • Phone: 515-710-4213
  • Fax: 719-434-9729
Mailing address:
  • Phone: 515-710-4213
  • Fax: 719-434-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY W CRISLIP
Title or Position: OWNER
Credential: DPM
Phone: 515-710-4213