Provider Demographics
NPI:1801008867
Name:EVEN, JILL D (LMT, CNMT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:D
Last Name:EVEN
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 FORTINO BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2087
Mailing Address - Country:US
Mailing Address - Phone:719-205-1645
Mailing Address - Fax:
Practice Address - Street 1:407 FORTINO BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2620
Practice Address - Country:US
Practice Address - Phone:719-205-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006650225700000X
CO707072204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM