Provider Demographics
NPI:1144418005
Name:WENDT, JOHN ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROSS
Last Name:WENDT
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 1:1600 HOVER ST
Mailing Address - Street 2:SUITE C 1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-678-1979
Mailing Address - Fax:303-678-5577
Practice Address - Street 1:1600 HOVER ST
Practice Address - Street 2:SUITE C 1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2462
Practice Address - Country:US
Practice Address - Phone:303-678-1979
Practice Address - Fax:303-678-5577
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4524Medicare PIN