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General NPI Number Information
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NPI Number | 1073344073
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Entity Type | Organization
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Legal Business Name | ALTITUDE NEROSTIMULATOR SERVICES
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 7669 E PHILLIPS CIR
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City | CENTENNIAL
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State | CO
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Zip | 80112-3250
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Country | US
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Telephone | 303-819-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 7669 E PHILLIPS CIR
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City | CENTENNIAL
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State | CO
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Zip | 80112-3250
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Country | US
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Telephone | 303-819-7464
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CHRISTOPHER JACKSON
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Credential | PA-C
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Telephone | 303-819-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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