Healthcare Provider Details

I. General information

NPI: 1700715331
Provider Name (Legal Business Name): CHRISTIAN JAMES KA'IPO ALLEN BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 KELLY JOHNSON BLVD STE 105
COLORADO SPRINGS CO
80920-3930
US

IV. Provider business mailing address

2554 OBSIDIAN FOREST VW
COLORADO SPRINGS CO
80951-9768
US

V. Phone/Fax

Practice location:
  • Phone: 719-867-5805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: