Healthcare Provider Details

I. General information

NPI: 1477759223
Provider Name (Legal Business Name): LEE JOSEPH BLACKWOOD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 BLACK FOREST RD STE 1
COLORADO SPRINGS CO
80908-3952
US

IV. Provider business mailing address

11145 EGERTON RD
COLORADO SPRINGS CO
80908-4306
US

V. Phone/Fax

Practice location:
  • Phone: 719-533-1100
  • Fax: 719-325-8988
Mailing address:
  • Phone: 719-533-1100
  • Fax: 719-359-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4920
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: