Healthcare Provider Details

I. General information

NPI: 1508951369
Provider Name (Legal Business Name): JEANNE M DESROCHE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 S QUEBEC ST SUITE 100
CENTENNIAL CO
80111-4671
US

IV. Provider business mailing address

6500 S QUEBEC ST SUITE 100
CENTENNIAL CO
80111-4671
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-2444
  • Fax: 303-741-0949
Mailing address:
  • Phone: 303-741-2444
  • Fax: 303-741-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2493
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: