Provider Demographics
NPI:1114385788
Name:BRIDGEWATER, JENNA LEA (DC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEA
Last Name:BRIDGEWATER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 HOLLOW BROOK DR
Mailing Address - Street 2:SUITE 70
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1451
Mailing Address - Country:US
Mailing Address - Phone:719-445-0806
Mailing Address - Fax:719-445-0998
Practice Address - Street 1:2155 HOLLOW BROOK DR
Practice Address - Street 2:SUITE 70
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1451
Practice Address - Country:US
Practice Address - Phone:719-445-0806
Practice Address - Fax:719-445-0998
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007379111N00000X
COEL.2786474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor