Provider Demographics
NPI:1659347227
Name:HIRONYMOUS, JESSE SUTTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:SUTTON
Last Name:HIRONYMOUS
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 1:3510 GALLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4312
Mailing Address - Country:US
Mailing Address - Phone:719-380-0138
Mailing Address - Fax:719-380-8055
Practice Address - Street 1:3510 GALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4312
Practice Address - Country:US
Practice Address - Phone:719-380-0138
Practice Address - Fax:719-380-8055
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06903111NN0400X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
613705Medicare PIN
U76435Medicare UPIN