Provider Demographics
NPI:1851062442
Name:WEAR, JAY C
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:WEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 9TH AVE APT 7208
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4068
Mailing Address - Country:US
Mailing Address - Phone:253-381-0133
Mailing Address - Fax:
Practice Address - Street 1:1044 W DRAKE RD STE 202
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-3080
Practice Address - Country:US
Practice Address - Phone:970-776-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist