Provider Demographics
NPI:1447688627
Name:HEALTHSOURCE OF DTC, P.C.
Entity type:Organization
Organization Name:HEALTHSOURCE OF DTC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRISIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLOWISKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-290-0022
Mailing Address - Street 1:5105 DTC PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2610
Mailing Address - Country:US
Mailing Address - Phone:303-290-0022
Mailing Address - Fax:303-290-9476
Practice Address - Street 1:5105 DTC PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2610
Practice Address - Country:US
Practice Address - Phone:303-290-0022
Practice Address - Fax:303-290-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5504261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA4439OtherMEDICARE PTAN