Healthcare Provider Details

I. General information

NPI: 1760326409
Provider Name (Legal Business Name): JACKS AXE THROWING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 CUMBERLAND ST
COLORADO SPRINGS CO
80907-4850
US

IV. Provider business mailing address

1223 CUMBERLAND ST
COLORADO SPRINGS CO
80907-4850
US

V. Phone/Fax

Practice location:
  • Phone: 719-659-8946
  • Fax:
Mailing address:
  • Phone: 719-659-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: BRYAN ROSSMANITH
Title or Position: OPERATIONS MANAGER/OWNER
Credential:
Phone: 719-659-8946