Healthcare Provider Details

I. General information

NPI: 1346428992
Provider Name (Legal Business Name): JOHN CALLAN ORTHOTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 N WEBER ST
COLORADO SPRINGS CO
80907-7503
US

IV. Provider business mailing address

PO BOX 1358
COLORADO SPRINGS CO
80901-1358
US

V. Phone/Fax

Practice location:
  • Phone: 719-799-6529
  • Fax:
Mailing address:
  • Phone: 719-799-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number04258361-0000
License Number StateCO

VIII. Authorized Official

Name: MR. JOHN MICHAEL CALLAN
Title or Position: PRESIDENT
Credential: C.O.
Phone: 719-799-6529