MEDICARE: COLORADO SPRINGS REGENERATIVE MEDICINE INC

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
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1346730967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPRINGS REGENERATIVE MEDICINE INC

Provider Business Mailing Address
First Line	:	1465 KELLY JOHNSON BLVD STE 300
Second Line	:
City	:	CO SPGS
State	:	CO
Zip	:	80920-3947
Country	:	US
Telephone Number	:	719-308-2314
Fax Number	:	719-694-0211

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 300
Second Line	:
City	:	CO SPGS
State	:	CO
Zip	:	80920-3947
Country	:	US
Telephone Number	:	719-308-2314
Fax Number	:	719-694-0211

Authorized Official
Title or Position	:	OWNER
Name	:	DEAN JONES
Credential	:	DC
Telephone Number	:	719-308-2314

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	10/08/2019

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