Healthcare Provider Details

I. General information

NPI: 1598401101
Provider Name (Legal Business Name): CHASE BRADFORD JACKSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 1183
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

5775 THURBER DR
COLORADO SPRINGS CO
80924-2102
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax: 719-365-2837
Mailing address:
  • Phone: 801-376-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0077701
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: