=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942708326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCKY BREAK ORTHOPEDICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2018
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 W TOMICHI AVE STE B
-----------------------------------------------------
City | GUNNISON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81230-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-672-1980
-----------------------------------------------------
Fax | 970-817-2112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1627
-----------------------------------------------------
City | CRESTED BUTTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81224-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID HENRY ELFENBEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 970-672-1980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 56343
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------