Basic Information
| Provider Information | |||||||||
| NPI: | 1487636247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSTEOPATHIC TREATMENT CENTER P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 697 1675 RD | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708749595 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Practice Location | |||||||||
| Address1: | 697 1675 RD | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708749595 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | JENKINS | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9702408822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 30332 | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 208100000X | 30332 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.