Provider Demographics
NPI:1710468921
Name:SOWELL-HUNDON, JADE CHAVALIAR (ATC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:CHAVALIAR
Last Name:SOWELL-HUNDON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 GRAND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8074
Mailing Address - Country:US
Mailing Address - Phone:916-578-0802
Mailing Address - Fax:
Practice Address - Street 1:2646 PATTERSON RD STE A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1941
Practice Address - Country:US
Practice Address - Phone:970-242-5585
Practice Address - Fax:970-242-1740
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer