Healthcare Provider Details

I. General information

NPI: 1356704001
Provider Name (Legal Business Name): FOUNTAIN CHIROPRACTIC AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 N. SANTA FE AVE
FOUNTAIN CO
80817
US

IV. Provider business mailing address

468 N. SANTA FE AVE
FOUNTAIN CO
80817
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAROD KEITH WATERS
Title or Position: OWNER
Credential: DC
Phone: 719-799-6555