Provider Demographics
NPI:1982937926
Name:JACKSON FISK INTEGRATIVE HEALTH CARE
Entity Type:Organization
Organization Name:JACKSON FISK INTEGRATIVE HEALTH CARE
Other - Org Name:JACKSON FISK BODY & SOUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-377-2399
Mailing Address - Street 1:3944 JFK PARKWAY
Mailing Address - Street 2:SUITE 12 B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-377-2399
Mailing Address - Fax:970-797-1729
Practice Address - Street 1:3944 JFK PKWY
Practice Address - Street 2:SUITE 12 B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3088
Practice Address - Country:US
Practice Address - Phone:970-377-2399
Practice Address - Fax:970-797-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6241111N00000X
CO6236111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty