Provider Demographics
NPI:1073345625
Name:BINNENDYK, JENNIFER CORRINE (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CORRINE
Last Name:BINNENDYK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35372 CR. AA
Mailing Address - Street 2:
Mailing Address - City:HILLROSE
Mailing Address - State:CO
Mailing Address - Zip Code:80733
Mailing Address - Country:US
Mailing Address - Phone:970-380-9005
Mailing Address - Fax:
Practice Address - Street 1:28601 US HIGHWAY 34 STE 207
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-9278
Practice Address - Country:US
Practice Address - Phone:970-380-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist