Provider Demographics
NPI:1043521495
Name:WEIGEL, JESSE T (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:T
Last Name:WEIGEL
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 1:2993 S PEORIA ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3107
Mailing Address - Country:US
Mailing Address - Phone:303-873-6232
Mailing Address - Fax:303-337-5474
Practice Address - Street 1:2993 S PEORIA ST
Practice Address - Street 2:SUITE 270
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3107
Practice Address - Country:US
Practice Address - Phone:303-873-6232
Practice Address - Fax:303-337-5474
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR6542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA109100OtherMEDICARE PTAN