Provider Demographics
NPI:1780708461
Name:SELANO, JEFFREY L (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SELANO
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 1:6726 S REVERE PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3962
Mailing Address - Country:US
Mailing Address - Phone:720-681-6170
Mailing Address - Fax:720-928-5516
Practice Address - Street 1:6726 S REVERE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3962
Practice Address - Country:US
Practice Address - Phone:720-681-6170
Practice Address - Fax:720-928-5516
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005181111N00000X
COCHR.00007356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000201584Medicaid
GA443072OtherBCBS PROVIDER
GA443072OtherBCBS PROVIDER