Healthcare Provider Details

I. General information

NPI: 1144773524
Provider Name (Legal Business Name): CHRISTOPHER M HANIFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

71 PORTERS PASS APT #1
BERLIN CT
06037-1415
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6820
  • Fax: 719-365-6595
Mailing address:
  • Phone: 727-543-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3715
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005780
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: