Provider Demographics
NPI:1477759223
Name:BLACKWOOD, LEE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JOSEPH
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11145 EGERTON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4306
Mailing Address - Country:US
Mailing Address - Phone:719-533-1100
Mailing Address - Fax:719-359-8484
Practice Address - Street 1:11425 BLACK FOREST RD STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3952
Practice Address - Country:US
Practice Address - Phone:719-533-1100
Practice Address - Fax:719-325-8988
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4920111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition