MEDICARE: DR. JESSE SUTTON HIRONYMOUS DC

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	111NN0400X	Neurology Chiropractor	06903	CO
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	06903	CO
3	111N00000X	Chiropractor	06903	CO

General Provider Information

NPI Number	:	1659347227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE SUTTON HIRONYMOUS DC

Provider Business Mailing Address
First Line	:	8011 WATERVALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8025
Country	:	US
Telephone Number	:	713-962-5356
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 WINDCHIME PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1984
Country	:	US
Telephone Number	:	713-962-5356
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	05/21/2025

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