Provider Demographics
NPI:1346493020
Name:HETTICH, JENNY MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:MICHELLE
Last Name:HETTICH
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:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-0763
Mailing Address - Country:US
Mailing Address - Phone:303-652-9200
Mailing Address - Fax:303-652-9202
Practice Address - Street 1:263 2ND AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80544
Practice Address - Country:US
Practice Address - Phone:303-652-9200
Practice Address - Fax:303-652-9202
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6078111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor