Organization
COLORADO LIFESTYLE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE BERNARD AYDELOTT (CO-OWNER)
(303) 988-4875
Entity
Organization
Contact information
Practice address
11904 W CEDAR DR, LAKEWOOD, CO 80228-2208
(303) 988-4875
Mailing address
11904 W CEDAR DR, LAKEWOOD, CO 80228-2208
(303) 988-4875
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
42-40450-0000
CO
Other
Enumeration date
08/22/2007
Last updated
08/22/2007
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