| NPI | 1366360489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM IVAN JACKSON Senior Clinician 719-433-4759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-07-07 |