MEDICARE: DR. JONATHAN DAVID SCHNELLE 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	5537	CO

General Provider Information

NPI Number	:	1205999141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DAVID SCHNELLE D.C.

Provider Business Mailing Address
First Line	:	2919 VALMONT RD
Second Line	:	SUITE 104
City	:	BOULDER
State	:	CO
Zip	:	80301-1350
Country	:	US
Telephone Number	:	303-442-2126
Fax Number	:	303-444-0665

Provider Business Practice Location Address
First Line	:	2919 VALMONT RD
Second Line	:	SUITE 104
City	:	BOULDER
State	:	CO
Zip	:	80301-1350
Country	:	US
Telephone Number	:	303-442-2126
Fax Number	:	303-444-0665

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/03/2009

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