Provider Demographics
NPI:1679923718
Name:COLORADO BACK INSTITUTE
Entity type:Organization
Organization Name:COLORADO BACK INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-594-2686
Mailing Address - Street 1:10535 PARK MEADOWS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-8401
Mailing Address - Country:US
Mailing Address - Phone:303-594-2686
Mailing Address - Fax:855-620-8714
Practice Address - Street 1:10535 PARK MEADOWS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8401
Practice Address - Country:US
Practice Address - Phone:303-594-2686
Practice Address - Fax:855-620-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty