Provider Demographics
NPI:1912084575
Name:KELLAMS, JINGER (DC)
Entity Type:Individual
Prefix:
First Name:JINGER
Middle Name:
Last Name:KELLAMS
Suffix:
Gender:F
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:PO BOX 273454
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-3454
Mailing Address - Country:US
Mailing Address - Phone:970-223-6561
Mailing Address - Fax:970-267-6537
Practice Address - Street 1:2850 MCCLELLAND DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2586
Practice Address - Country:US
Practice Address - Phone:970-223-6561
Practice Address - Fax:970-267-6537
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU92428Medicare UPIN
COC474838Medicare PIN