Provider Demographics
NPI:1508951369
Name:DESROCHE, JEANNE M (DC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:DESROCHE
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 1:6500 S QUEBEC ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4671
Mailing Address - Country:US
Mailing Address - Phone:303-741-2444
Mailing Address - Fax:303-741-0949
Practice Address - Street 1:6500 S QUEBEC ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4671
Practice Address - Country:US
Practice Address - Phone:303-741-2444
Practice Address - Fax:303-741-0949
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2493111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22553Medicare ID - Type Unspecified
COT60644Medicare UPIN