Healthcare Provider Details

I. General information

NPI: 1093968430
Provider Name (Legal Business Name): JAROD KEITH WATERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 N SANTA FE AVE
FOUNTAIN CO
80817-1742
US

IV. Provider business mailing address

468 N SANTA FE AVE
FOUNTAIN CO
80817-1742
US

V. Phone/Fax

Practice location:
  • Phone: 719-799-6555
  • Fax: 719-302-5680
Mailing address:
  • Phone: 719-799-6555
  • Fax: 719-302-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number7180
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number7180
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: