=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518377357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KB HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2014
-----------------------------------------------------
Last Update Date | 05/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2433 W 44TH AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80211-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-539-9362
-----------------------------------------------------
Fax | 773-382-8622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 S CHEROKEE ST APT 3306
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80223-2093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-539-9362
-----------------------------------------------------
Fax | 773-382-8622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KATELYN INTRES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 630-774-3865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | CHR.0007089
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------