Healthcare Provider Details

I. General information

NPI: 1073344073
Provider Name (Legal Business Name): ALTITUDE NEROSTIMULATOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7669 E PHILLIPS CIR
CENTENNIAL CO
80112-3250
US

IV. Provider business mailing address

7669 E PHILLIPS CIR
CENTENNIAL CO
80112-3250
US

V. Phone/Fax

Practice location:
  • Phone: 303-819-7464
  • Fax:
Mailing address:
  • Phone: 303-819-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER JACKSON
Title or Position: FOUNDER
Credential: PA-C
Phone: 303-819-7464