Provider Demographics
NPI:1033203138
Name:LEVI, JERRY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:LEVI
Suffix:JR
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 1:1465 KELLY JOHNSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3945
Mailing Address - Country:US
Mailing Address - Phone:719-593-1227
Mailing Address - Fax:
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3945
Practice Address - Country:US
Practice Address - Phone:719-593-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3926Medicare PIN