Healthcare Provider Details

I. General information

NPI: 1386602928
Provider Name (Legal Business Name): JACLYN MARIE ADAMS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLETON AVE
BOULDER CO
80304-3979
US

IV. Provider business mailing address

126 4TH STREET POB 1084
FIRESTONE CO
80520-1084
US

V. Phone/Fax

Practice location:
  • Phone: 303-544-5700
  • Fax: 303-544-5710
Mailing address:
  • Phone: 303-918-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: