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Contact Information

BUCK JACK LLC
1301 FORTINO BLVD
PUEBLO, CO81008-2032
 Phone: 719-696-7799
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
 

Behavior Analyst

103K00000X
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BUCK JACK LLC

NPI # 1619580735
LBN Legal business name BUCK JACK LLC
Authorized official TANNER DENN - (CREDENTIALING SPECIALIST)
Entity Organization
Organization subpart 1 No
Enumeration date 08/28/2020
Last updated 02/28/2024 - About 2 years ago
Identifiers
CO Medicaid 9000188140
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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