Healthcare Provider Details

I. General information

NPI: 1194913384
Provider Name (Legal Business Name): JARED WAYNE ALLOMONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
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
80501-2462
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHR-6140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: