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General NPI Number Information
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NPI Number | 1619129269
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Entity Type | Organization
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Legal Business Name | JK BLIXT D.O. INC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1715 N WEBER ST STE 260
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7553
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Country | US
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Telephone | 719-896-4794
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Fax | 719-896-5484
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Provider Business Mailing Address
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Address Line | 1715 N WEBER ST STE 260
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7553
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Country | US
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Telephone | 719-896-4794
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Fax | 719-896-5484
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JEFFREY BLIXT
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Credential | DO,FASAM
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Telephone | 719-896-4794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38650
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License Number State | CO
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