Provider Demographics
NPI:1003948951
Name:AUTH, JEFFREY B (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:AUTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:114 VILLAGE PLACE SUITE 201 A
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-0656
Mailing Address - Country:US
Mailing Address - Phone:970-262-7929
Mailing Address - Fax:970-262-7971
Practice Address - Street 1:114 VILLAGE PLACE
Practice Address - Street 2:SUITE 201 A
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-0656
Practice Address - Country:US
Practice Address - Phone:970-262-7929
Practice Address - Fax:970-262-7971
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU83115Medicare UPIN
COC44693Medicare ID - Type UnspecifiedPROVIDER NUMBER