Healthcare Provider Details

I. General information

NPI: 1447170741
Provider Name (Legal Business Name): ADAM W JATCZAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 28 1/4 RD UNIT 1
GRAND JUNCTION CO
81501-4961
US

IV. Provider business mailing address

2839 ELM AVE UNIT C
GRAND JUNCTION CO
81501-5304
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0028116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: