Healthcare Provider Details

I. General information

NPI: 1144418005
Provider Name (Legal Business Name): JOHN ROSS WENDT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOVER ST SUITE C 1
LONGMONT CO
80501-2462
US

IV. Provider business mailing address

1600 HOVER ST SUITE C 1
LONGMONT CO
80501
US

V. Phone/Fax

Practice location:
  • Phone: 303-678-1979
  • Fax: 303-678-5577
Mailing address:
  • Phone: 303-678-1979
  • Fax: 303-678-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: