Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6506 | CO |
N | 111NN0400X | Neurology | 6506 | CO |
N | 111NN1001X | Nutrition | 6506 | CO |
N | 111NP0017X | Pediatric Chiropractor | 6506 | CO |
N | 111NR0200X | Radiology | 6506 | CO |
N | 213ER0200X | Radiology | 6506 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | 6506 | CO |
N | 111NS0005X | Chiropractic Sports Physician | 6506 | CO |
N | 111NT0100X | Thermography | 6506 | CO |
N | 111NX0100X | Occupational Health | 6506 | CO |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 6506 | CO |
NPI | 1033436852 |
---|---|
Provider Name | Jacob Glenn Fletcher |
First Address | Lakewood, CO 80214-5287 |
Second Address | Lakewood, CO 80214-5287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 04/02/2014 |