Provider Demographics
NPI:1295803336
Name:ALTHOFF, JILL R (DC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:R
Last Name:ALTHOFF
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 1:1040 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4762
Mailing Address - Country:US
Mailing Address - Phone:970-686-6833
Mailing Address - Fax:970-686-6837
Practice Address - Street 1:1040 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4762
Practice Address - Country:US
Practice Address - Phone:970-686-6833
Practice Address - Fax:970-686-6837
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0005424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC491148Medicare ID - Type Unspecified