MEDICARE: KELSIE COLFACK ATC

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	2255A2300X	Athletic Trainer	096902	IA

General Provider Information

NPI Number	:	1841099124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE COLFACK ATC

Provider Business Mailing Address
First Line	:	3303 REBECCA ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2324
Country	:	US
Telephone Number	:	515-681-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 REBECCA ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2324
Country	:	US
Telephone Number	:	515-681-6152
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “ KELSIE COLFACK ATC” Practice Location

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