Healthcare Provider Details

I. General information

NPI: 1063322097
Provider Name (Legal Business Name): A1BOXING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 WORCHESTER ST
DENVER CO
80239-4363
US

IV. Provider business mailing address

4930 WORCHESTER ST
DENVER CO
80239-4363
US

V. Phone/Fax

Practice location:
  • Phone: 720-933-8829
  • Fax:
Mailing address:
  • Phone: 720-933-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: GLENN GOODSON
Title or Position: OWNER
Credential:
Phone: 720-933-8829