Provider Demographics
NPI:1104986819
Name:BAILEY, CHRISTIAN BLAKE (CPO)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:BLAKE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:695 S COLORADO BLVD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-8008
Mailing Address - Country:US
Mailing Address - Phone:303-346-1906
Mailing Address - Fax:303-962-1820
Practice Address - Street 1:695 S COLORADO BLVD
Practice Address - Street 2:SUITE #220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8008
Practice Address - Country:US
Practice Address - Phone:303-346-1906
Practice Address - Fax:303-962-1820
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPO1908222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38833051Medicaid
CO5563310001Medicare NSC