Provider Demographics
NPI:1669019303
Name:MOUNTAIN FAMILY WELLNESS, LLC
Entity Type:Organization
Organization Name:MOUNTAIN FAMILY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:LADONNA
Authorized Official - Last Name:JAUERNIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-845-0001
Mailing Address - Street 1:500 SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2517
Mailing Address - Country:US
Mailing Address - Phone:719-845-0001
Mailing Address - Fax:
Practice Address - Street 1:500 SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2517
Practice Address - Country:US
Practice Address - Phone:719-845-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty