Provider Demographics
NPI:1154367076
Name:COREANCE, INC.
Entity type:Organization
Organization Name:COREANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CPT
Authorized Official - Phone:303-444-2951
Mailing Address - Street 1:2935 BASELINE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2366
Mailing Address - Country:US
Mailing Address - Phone:303-444-2951
Mailing Address - Fax:303-444-4779
Practice Address - Street 1:2935 BASELINE RD
Practice Address - Street 2:STE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2366
Practice Address - Country:US
Practice Address - Phone:303-444-2951
Practice Address - Fax:303-444-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066603Medicare ID - Type UnspecifiedMEDICARE NUMBER