Healthcare Provider Details

I. General information

NPI: 1700343746
Provider Name (Legal Business Name): DANIEL HUTCHISON ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-3480
US

IV. Provider business mailing address

4105 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-3487
US

V. Phone/Fax

Practice location:
  • Phone: 719-482-8350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberAT.0001666
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: