Provider Demographics
NPI:1194913384
Name:ALLOMONG, JARED WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:WAYNE
Last Name:ALLOMONG
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 1:1600 HOVER ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2462
Mailing Address - Country:US
Mailing Address - Phone:303-678-1979
Mailing Address - Fax:
Practice Address - Street 1:1600 HOVER ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2462
Practice Address - Country:US
Practice Address - Phone:303-678-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6140111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition