Provider Demographics
NPI:1750569521
Name:DEVEAU, JILL ROBIN (DC, LAC)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:ROBIN
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTH DUDLEY STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:720-979-7864
Mailing Address - Fax:
Practice Address - Street 1:1120 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2112
Practice Address - Country:US
Practice Address - Phone:303-832-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6352111N00000X
CO1505171100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program