MEDICARE: JJ ELEVATION, PLLC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1447803382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJ ELEVATION, PLLC

Provider Business Mailing Address
First Line	:	10012 COYOTE SONG TER
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-4504
Country	:	US
Telephone Number	:	719-357-1336
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 COYOTE SONG TER
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-4504
Country	:	US
Telephone Number	:	719-357-1336
Fax Number	:

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. ADAM JOHN MCKISSOCK
Credential	:	DMD
Telephone Number	:	719-357-1336

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	11/17/2023

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