Healthcare Provider Details

I. General information

NPI: 1003083841
Provider Name (Legal Business Name): CHEYENNE FOOT & ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 PHAY AVE SUITE D
CANON CITY CO
81212-2334
US

IV. Provider business mailing address

2620 TENDERFOOT HILL ST STE 10
COLORADO SPRINGS CO
80906-8353
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-1037
  • Fax: 719-275-1305
Mailing address:
  • Phone: 719-576-2080
  • Fax: 719-576-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number642
License Number StateCO

VIII. Authorized Official

Name: DR. JENNIFER V YULL
Title or Position: PHYSICIAN OWNER
Credential: DPM
Phone: 719-576-2080