Provider Demographics
NPI:1700118676
Name:HLAVINKA, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:HLAVINKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:HLAVINKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2321 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1103
Mailing Address - Country:US
Mailing Address - Phone:303-440-3998
Mailing Address - Fax:303-440-8363
Practice Address - Street 1:2321 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1103
Practice Address - Country:US
Practice Address - Phone:303-440-3998
Practice Address - Fax:303-440-8363
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist