Provider Demographics
NPI:1770065237
Name:CRANIAL KIDS LLC
Entity type:Organization
Organization Name:CRANIAL KIDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:THESSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-684-4008
Mailing Address - Street 1:1624 SAND RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9206
Mailing Address - Country:US
Mailing Address - Phone:171-968-4400
Mailing Address - Fax:719-960-2074
Practice Address - Street 1:520 W BUENA VENTURA ST STE 115
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7206
Practice Address - Country:US
Practice Address - Phone:719-896-5924
Practice Address - Fax:719-960-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02572222Z00000X, 224P00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty