Provider Demographics
NPI:1205999141
Name:SCHNELLE, JONATHAN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:SCHNELLE
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 1:2919 VALMONT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1350
Mailing Address - Country:US
Mailing Address - Phone:303-442-2126
Mailing Address - Fax:303-444-0665
Practice Address - Street 1:2919 VALMONT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1350
Practice Address - Country:US
Practice Address - Phone:303-442-2126
Practice Address - Fax:303-444-0665
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO530768Medicare PIN
COU99054Medicare UPIN