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General NPI Number Information
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NPI Number | 1194156885
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Entity Type | Organization
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Legal Business Name | NEURO LOGICAL, LLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 2770 ARAPAHOE RD SUITE 132 PMB 249
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City | LAFAYETTE
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State | CO
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Zip | 80026-8018
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Country | US
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Telephone | 303-249-7295
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Fax | 720-564-1200
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Provider Business Mailing Address
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Address Line | 2770 ARAPAHOE RD SUITE 132 PMB 249
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City | LAFAYETTE
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State | CO
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Zip | 80026-8018
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Country | US
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Telephone | 303-249-7295
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Fax | 720-564-1200
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Authorized Official
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Title or Position | MANAGER
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Name | JAN DECHANT
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Credential |
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Telephone | 303-249-7295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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