Provider Demographics
NPI:1093847618
Name:MURRAY, JENNIFER A (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:MURRAY
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 1:705 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2859
Mailing Address - Country:US
Mailing Address - Phone:719-276-2578
Mailing Address - Fax:
Practice Address - Street 1:705 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2859
Practice Address - Country:US
Practice Address - Phone:719-276-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45329Medicare UPIN
C44873Medicare ID - Type Unspecified