Provider Demographics
NPI:1528429677
Name:KUBAN, JEREMY
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:KUBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 W JEWELL AVE
Mailing Address - Street 2:APT 12-308
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6237
Mailing Address - Country:US
Mailing Address - Phone:303-513-7476
Mailing Address - Fax:
Practice Address - Street 1:5912 S CODY ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-9542
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist