MEDICARE: HEADACHE CENTER CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist
2	207YX0901X	Otology & Neurotology Physician

General Provider Information

NPI Number	:	1588284012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEADACHE CENTER CO

Provider Business Mailing Address
First Line	:	7621 AUSTIN BLUFFS PKWY UNIT 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2904
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:	719-596-0890

Provider Business Practice Location Address
First Line	:	7621 AUSTIN BLUFFS PKWY UNIT 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2904
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:	719-596-0890

Authorized Official
Title or Position	:	OWNER
Name	:	JOEL RAUSER
Credential	:
Telephone Number	:	719-596-5000

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	09/24/2020

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