Provider Demographics
NPI:1417066572
Name:BOGGS REED, JEANETTE JOYCE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:JOYCE
Last Name:BOGGS REED
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 1:12548 W 1ST PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5004
Mailing Address - Country:US
Mailing Address - Phone:303-862-2181
Mailing Address - Fax:
Practice Address - Street 1:570 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4002
Practice Address - Country:US
Practice Address - Phone:303-862-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24851111N00000X
CADC24851111N00000X
CO6139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24851Medicare PIN
CADC0248510Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAU69721Medicare UPIN