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General NPI Number Information
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NPI Number | 1609297969
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Entity Type | Organization
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Legal Business Name | SPINE RE-NEW LLC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 7200 E DRY CREEK RD A101
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City | CENTENNIAL
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State | CO
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Zip | 80112-2537
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Country | US
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Telephone | 303-351-3590
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Fax | 303-552-2078
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Provider Business Mailing Address
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Address Line | 7200 E DRY CREEK RD A101
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City | CENTENNIAL
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State | CO
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Zip | 80112-2537
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Country | US
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Telephone | 303-351-3590
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Fax | 303-552-2078
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRIAN R BERLENER
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Credential | D.C.
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Telephone | 303-351-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6253
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License Number State | CO
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