Provider Demographics
NPI:1043227390
Name:JACHIMIAK, JOHN S (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:JACHIMIAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 PEARL ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3851
Mailing Address - Country:US
Mailing Address - Phone:303-442-2910
Mailing Address - Fax:303-442-2931
Practice Address - Street 1:2575 PEARL ST
Practice Address - Street 2:SUITE 240
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3851
Practice Address - Country:US
Practice Address - Phone:303-442-2910
Practice Address - Fax:303-442-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 526213EP1101X, 213ES0000X, 213ES0103X
COCO526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01005263Medicaid
CO01005263Medicaid
COCO41024Medicare PIN