Healthcare Provider Details

I. General information

NPI: 1851371942
Provider Name (Legal Business Name): CHEYENNE FOOT & ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 BROADMOOR VALLEY RD STE 104
COLORADO SPRINGS CO
80906-3981
US

IV. Provider business mailing address

2975 BROADMOOR VALLEY RD STE 104
COLORADO SPRINGS CO
80906-3981
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-2080
  • Fax: 719-576-2248
Mailing address:
  • Phone: 719-576-2080
  • Fax: 719-576-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. JENNIFER V YULL
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 719-576-2080