Healthcare Provider Details

I. General information

NPI: 1851503544
Provider Name (Legal Business Name): CHANCE JACK HENDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 RESEARCH PKWY STE 200
COLORADO SPRINGS CO
80920-1087
US

IV. Provider business mailing address

8101 E LOWRY BLVD STE 120
DENVER CO
80230-7195
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-1050
  • Fax:
Mailing address:
  • Phone: 303-806-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberN8660
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036.142192
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberDR.0051822
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: