Provider Demographics
NPI:1205994514
Name:AMSDEN, JEFFREY J (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:AMSDEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3472 RESEARCH PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1066
Mailing Address - Country:US
Mailing Address - Phone:719-494-2088
Mailing Address - Fax:719-282-6464
Practice Address - Street 1:8842 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7798
Practice Address - Country:US
Practice Address - Phone:719-494-2088
Practice Address - Fax:719-282-6464
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU95163Medicare UPIN
CO497058Medicare ID - Type UnspecifiedPROVIDER NUMBER
CO497048Medicare ID - Type UnspecifiedGROUP PROVIDER ID NUMBER