MEDICARE: DR. LEE JOSEPH BLACKWOOD DC

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	111NN1001X	Nutrition Chiropractor	4920	CO

General Provider Information

NPI Number	:	1477759223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE JOSEPH BLACKWOOD DC

Provider Business Mailing Address
First Line	:	11145 EGERTON RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4306
Country	:	US
Telephone Number	:	719-533-1100
Fax Number	:	719-359-8484

Provider Business Practice Location Address
First Line	:	11425 BLACK FOREST RD STE 1
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-3952
Country	:	US
Telephone Number	:	719-533-1100
Fax Number	:	719-325-8988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	05/13/2020

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