Provider Demographics
NPI:1427152032
Name:COLORADO SPRINGS OSTEOPATHIC FOUNDATION
Entity type:Organization
Organization Name:COLORADO SPRINGS OSTEOPATHIC FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEETHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-635-2823
Mailing Address - Street 1:3480 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4087
Mailing Address - Country:US
Mailing Address - Phone:719-635-2823
Mailing Address - Fax:719-635-4727
Practice Address - Street 1:3480 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4087
Practice Address - Country:US
Practice Address - Phone:719-635-2823
Practice Address - Fax:719-635-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty