Provider Demographics
NPI:1093968430
Name:WATERS, JAROD KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:JAROD
Middle Name:KEITH
Last Name:WATERS
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 1:468 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1742
Mailing Address - Country:US
Mailing Address - Phone:719-799-6555
Mailing Address - Fax:719-302-5680
Practice Address - Street 1:468 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1742
Practice Address - Country:US
Practice Address - Phone:719-799-6555
Practice Address - Fax:719-302-5680
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7180111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition