Provider Demographics
NPI:1063220168
Name:DEMPSEY, ELIJAH CADE (LMT)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:CADE
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 FILLMORE ST STE GL3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1546
Mailing Address - Country:US
Mailing Address - Phone:719-839-5547
Mailing Address - Fax:
Practice Address - Street 1:1633 FILLMORE ST STE GL3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1546
Practice Address - Country:US
Practice Address - Phone:719-839-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist