DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: BUCK JACK, LLC

MEDICARE: BUCK JACK, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1205624111
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUCK JACK, LLC
Provider Business Mailing Address
First Line : 2233 ACADEMY PL STE 200
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-1666
Country : US
Telephone Number : 719-597-0822
Fax Number : 719-599-4606
Provider Business Practice Location Address
First Line : 304 E ROUTT AVE
Second Line :
City : PUEBLO
State : CO
Zip : 81004-2122
Country : US
Telephone Number : 719-597-0822
Fax Number : 719-599-4606
Authorized Official
Title or Position : INTERNAL OPERATIONS MANAGER
Name : TANNER HALL
Credential :
Telephone Number : 719-597-0822
Provider Enumeration Date : 04/29/2025
Last Update Date : 04/29/2025

Similar Medicare Providers

1306704176 — MADISON EMILY DUDZIEC
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-357-4066
Practice Fax:
1114884939 — KIRALAYNE NICOLE BUSTAMANTE
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-357-4066
Practice Fax:
1295523108 — BUCK JACK, LLC
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-597-0822
Practice Fax: 719-599-4606
1508748187 — BUCK JACK, LLC
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-597-0822
Practice Fax:
1659244374 — MOUK PANY
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-597-0822
Practice Fax:
1588530158 — TAYLAH RAE VIGIL
Practice Location Address:
304 E ROUTT AVE
PUEBLO, CO
81004-2122
Practice Phone: 719-733-9255
Practice Fax:

Directions to “BUCK JACK, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.