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General NPI Number Information
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NPI Number | 1760228886
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Entity Type | Organization
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Legal Business Name | ENTEROTRACK LLC
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 12635 E MONTVIEW BLVD STE 215LC
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City | AURORA
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State | CO
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Zip | 80045-7335
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Country | US
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Telephone | 303-652-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 KINGWOOD PL
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City | BOULDER
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State | CO
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Zip | 80304-1527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBIN SHANDAS
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Credential |
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Telephone | 303-652-7338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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