Provider Demographics
NPI:1588804991
Name:LEUSDEN, JONATHAN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LEUSDEN
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 1:104 S. CASCADE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-322-4234
Mailing Address - Fax:
Practice Address - Street 1:104 S. CASCADE
Practice Address - Street 2:SUITE 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-322-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor