Provider Demographics
NPI:1326217910
Name:KOMAREK, JAY (DC, CAC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:KOMAREK
Suffix:
Gender:M
Credentials:DC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6545
Mailing Address - Country:US
Mailing Address - Phone:970-385-0321
Mailing Address - Fax:970-385-0281
Practice Address - Street 1:925 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6545
Practice Address - Country:US
Practice Address - Phone:970-385-0321
Practice Address - Fax:970-385-0281
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor