Provider Demographics
NPI:1225693799
Name:JACOT-GUILLARMOD, DAVID ISAIAH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAIAH
Last Name:JACOT-GUILLARMOD
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 1:1057 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4360
Mailing Address - Country:US
Mailing Address - Phone:303-233-1236
Mailing Address - Fax:
Practice Address - Street 1:1057 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4360
Practice Address - Country:US
Practice Address - Phone:303-233-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor