Provider Demographics
NPI:1750468740
Name:CRISMON, JENNIFER LYN (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:CRISMON
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 1:2220 S FRASER ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4507
Mailing Address - Country:US
Mailing Address - Phone:303-750-9868
Mailing Address - Fax:303-750-0579
Practice Address - Street 1:2220 S FRASER ST
Practice Address - Street 2:UNIT 3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4507
Practice Address - Country:US
Practice Address - Phone:303-750-9868
Practice Address - Fax:303-750-0579
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO499128Medicare ID - Type Unspecified