Provider Demographics
NPI:1386060689
Name:COLORADO SPINE AND SPORT
Entity type:Organization
Organization Name:COLORADO SPINE AND SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-604-4358
Mailing Address - Street 1:335 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1196
Mailing Address - Country:US
Mailing Address - Phone:303-604-4358
Mailing Address - Fax:
Practice Address - Street 1:335 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1196
Practice Address - Country:US
Practice Address - Phone:303-604-4358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5130111N00000X
CO5684111N00000X
CO9340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty