NPIMap

Organization Active NPI

Buck Jack LLC

Doing business as The Shandy Clinic

  • Occupational Therapist
  • Colorado Springs, CO
National Provider Identifier
1497353700
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
BUCK JACK LLC
Doing business as
The Shandy Clinic
Practice address
2233 Academy PL Ste 201
Colorado Springs, CO 80909-1679
Phone
(719) 597-0822
Fax
(719) 599-4606
NPI assigned
Oct 9, 2020
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca Newman
Title
Billing Manager
Phone
(719) 597-0822

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Physical Therapist 225100000X
Occupational Therapist 225X00000X Primary
Speech-Language Pathologist 235Z00000X
Behavior Analyst 103K00000X

Addresses

Primary practice location

2233 Academy PL Ste 201
Colorado Springs, CO 80909-1679

Mailing address

685 Citadel Dr E Ste 580
Colorado Springs, CO 80909-5381
Phone (719) 597-0822

Other names 1

  • THE SHANDY CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buck Jack LLC70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1497353700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E STE 580",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095381",
            "telephone_number": "719-597-0822",
            "fax_number": "719-599-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 ACADEMY PL STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091679",
            "telephone_number": "719-597-0822",
            "fax_number": "719-599-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCK JACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-09",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "719-597-0822"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE SHANDY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.