MEDICARE: BOULDER COUNTY PRIMARY CARE AND REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1306383039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER COUNTY PRIMARY CARE AND REHAB

Provider Business Mailing Address
First Line	:	400 INDIANA ST STE 320
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-5033
Country	:	US
Telephone Number	:	303-842-0367
Fax Number	:	888-382-8131

Provider Business Practice Location Address
First Line	:	413 SUMMIT BLVD
Second Line	:	#101
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-8294
Country	:	US
Telephone Number	:	303-842-0367
Fax Number	:	888-382-8131

Authorized Official
Title or Position	:	PARTNER
Name	:	GARRET ROCK
Credential	:	D.C.
Telephone Number	:	303-842-0367

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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Directions to “BOULDER COUNTY PRIMARY CARE AND REHAB ” Practice Location

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