Active NPI
Jordan McQuade Coburn, LMT, CNMT
- Massage Therapist
- Colorado Springs, CO
National Provider Identifier
1750091187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT.0025055
- Practice address
- 617 N 17TH St Ste 230
Colorado Springs, CO 80904-3577 - Phone
- (719) 357-9822
- NPI assigned
- Nov 28, 2022
- Sex
- Male
- Sole proprietor
- No
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 | MT.0025055 | CO | Primary |
Addresses
Primary practice location
617 N 17TH St Ste 230
Colorado Springs, CO 80904-3577
Mailing address
3788 Red Canon PL Apt B
Colorado Springs, CO 80904-2316
Phone (979) 220-0704
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 |
|---|---|---|---|
| MT.0025055 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669593600000",
"number": "1750091187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3788 RED CANON PL APT B",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809042316",
"telephone_number": "979-220-0704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 N 17TH ST STE 230",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809043577",
"telephone_number": "719-357-9822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "JORDAN",
"middle_name": "MCQUADE",
"name_prefix": "Mr.",
"credential": "LMT, CNMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-28",
"last_updated": "2022-11-28",
"certification_date": "2022-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "MT.0025055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.