Healthcare Provider Details

I. General information

NPI: 1124995105
Provider Name (Legal Business Name): DR. JAZMIN GENESIS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 S COLLEGE AVE STE B
FORT COLLINS CO
80525-5404
US

IV. Provider business mailing address

2111 S COLLEGE AVE STE B
FORT COLLINS CO
80525-5404
US

V. Phone/Fax

Practice location:
  • Phone: 720-297-1086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0009006
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: