MEDICARE: JACLYNN ROWENHORST D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4534	OH

General Provider Information

NPI Number	:	1194105338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYNN ROWENHORST D.C

Provider Business Mailing Address
First Line	:	77 ERIE VILLAGE SQ UNIT 150
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-6995
Country	:	US
Telephone Number	:	720-600-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 ERIE VILLAGE SQ UNIT 150
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-6995
Country	:	US
Telephone Number	:	720-600-4661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	01/11/2021

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