Healthcare Provider Details

I. General information

NPI: 1841133113
Provider Name (Legal Business Name): KEN OBERMARK JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OFFICE CLUB PT STE 301
COLORADO SPRINGS CO
80920-5020
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 301
COLORADO SPRINGS CO
80920-5020
US

V. Phone/Fax

Practice location:
  • Phone: 719-212-1336
  • Fax:
Mailing address:
  • Phone: 719-212-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: