Provider Demographics
NPI:1912465865
Name:ALVIS, JACOB NATHANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NATHANIEL
Last Name:ALVIS
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 1:9898 ROSEMONT AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-4107
Mailing Address - Country:US
Mailing Address - Phone:719-574-6006
Mailing Address - Fax:
Practice Address - Street 1:9898 ROSEMONT AVE
Practice Address - Street 2:STE 101
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4107
Practice Address - Country:US
Practice Address - Phone:303-221-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor