Healthcare Provider Details

I. General information

NPI: 1982937926
Provider Name (Legal Business Name): JACKSON FISK INTEGRATIVE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 JFK PKWY SUITE 12 B
FORT COLLINS CO
80525-3088
US

IV. Provider business mailing address

3944 JFK PARKWAY SUITE 12 B
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-377-2399
  • Fax: 970-797-1729
Mailing address:
  • Phone: 970-377-2399
  • Fax: 970-797-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number6236
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6241
License Number StateCO

VIII. Authorized Official

Name: PETER FISK
Title or Position: PARTNER/SECRETARY
Credential: D.C.
Phone: 970-377-2399