Provider Demographics
NPI:1154435212
Name:DRAKE, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:FRICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1240 KEN PRATT BLVD
Mailing Address - Street 2:STE 7-3
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6003
Mailing Address - Country:US
Mailing Address - Phone:970-306-7277
Mailing Address - Fax:
Practice Address - Street 1:1240 KEN PRATT BLVD
Practice Address - Street 2:STE 7-3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6003
Practice Address - Country:US
Practice Address - Phone:970-306-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor