Healthcare Provider Details

I. General information

NPI: 1225466022
Provider Name (Legal Business Name): JENNIFER J JAMROG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 11/27/2023
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WINDWARD WAY STE 101
KALISPELL MT
59901-3385
US

IV. Provider business mailing address

245 WINDWARD WAY STE 101
KALISPELL MT
59901-3385
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-8488
  • Fax:
Mailing address:
  • Phone: 406-756-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberQ7895
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number57509
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: