Provider Demographics
NPI:1467665166
Name:ORGILL, JED RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:JED
Middle Name:RYAN
Last Name:ORGILL
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 1:303 E TOMICHI AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2164
Mailing Address - Country:US
Mailing Address - Phone:970-641-1554
Mailing Address - Fax:970-641-4596
Practice Address - Street 1:303 E TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2164
Practice Address - Country:US
Practice Address - Phone:970-641-1554
Practice Address - Fax:970-641-4596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor