Provider Demographics
NPI:1720108368
Name:CHEEK, JACQUELINE (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CHEEK
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:12389 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4478
Mailing Address - Country:US
Mailing Address - Phone:386-341-4410
Mailing Address - Fax:
Practice Address - Street 1:12401 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2548
Practice Address - Country:US
Practice Address - Phone:386-341-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF097ZOtherMEDICARE