Provider Demographics
NPI:1649869108
Name:SMART BODYWORK LLC
Entity type:Organization
Organization Name:SMART BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:303-345-5967
Mailing Address - Street 1:2080 S HOLLY ST UNIT 22311
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3014
Mailing Address - Country:US
Mailing Address - Phone:303-345-5967
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE 420
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2575
Practice Address - Country:US
Practice Address - Phone:303-345-5967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA94771OtherDHS
CO0021273OtherDORA