Provider Demographics
NPI:1053577759
Name:MUSTARD SEED WELLNESS, PC
Entity type:Organization
Organization Name:MUSTARD SEED WELLNESS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHRISTIANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, MTC
Authorized Official - Phone:303-902-5456
Mailing Address - Street 1:PO BOX 270217
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5003
Mailing Address - Country:US
Mailing Address - Phone:303-902-5456
Mailing Address - Fax:
Practice Address - Street 1:11025 DOVER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-5570
Practice Address - Country:US
Practice Address - Phone:303-902-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy