Provider Demographics
NPI:1740302975
Name:SHUM, JONATHAN C (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:SHUM
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 1:1225 KEN PRATT BLVD UNIT 222
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9017
Mailing Address - Country:US
Mailing Address - Phone:303-772-3100
Mailing Address - Fax:720-684-4928
Practice Address - Street 1:1225 KEN PRATT BLVD UNIT 222
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9017
Practice Address - Country:US
Practice Address - Phone:303-772-3100
Practice Address - Fax:720-684-4928
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44353Medicare ID - Type Unspecified
COU79615Medicare UPIN