Provider Demographics
NPI:1801063953
Name:JEWELL, MALCOLM EUGENE JR (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:EUGENE
Last Name:JEWELL
Suffix:JR
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1805
Mailing Address - Country:US
Mailing Address - Phone:303-666-8149
Mailing Address - Fax:303-666-9149
Practice Address - Street 1:722 FRONT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1805
Practice Address - Country:US
Practice Address - Phone:303-666-8149
Practice Address - Fax:303-666-9149
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO178237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist