Provider Demographics
NPI:1740350164
Name:NEWMAN, JERROD M (DC)
Entity type:Individual
Prefix:
First Name:JERROD
Middle Name:M
Last Name:NEWMAN
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 1:2220 DELL RANGE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4951
Mailing Address - Country:US
Mailing Address - Phone:307-638-6588
Mailing Address - Fax:307-638-6199
Practice Address - Street 1:2220 DELL RANGE BLVD. STE #102
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4951
Practice Address - Country:US
Practice Address - Phone:307-638-6588
Practice Address - Fax:307-638-6199
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU97735Medicare UPIN