Active NPI
Tad D Childers
- Massage Therapist
- Pueblo, CO
National Provider Identifier
1083987762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 6794
- Practice address
- 2310 S Prairie Ave
Pueblo, CO 81005-4801 - Phone
- (719) 406-3210
- NPI assigned
- Feb 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 6794 | CO | Primary |
Addresses
Primary practice location
2310 S Prairie Ave
Pueblo, CO 81005-4801
Mailing address
1041 Cypress St
Pueblo, CO 81004-2503
Phone (719) 406-3210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6794 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transitions Bodywork Clinic Inc. | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Massage Therapist
- Pueblo, CO
- NPI 1992198261
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426032000000",
"number": "1083987762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1041 CYPRESS ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810042503",
"telephone_number": "719-406-3210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2310 S PRAIRIE AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810054801",
"telephone_number": "719-406-3210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDERS",
"first_name": "TAD",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-10",
"last_updated": "2015-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "6794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.