Provider Demographics
NPI:1194943100
Name:KOONTZ, JENNIFER (DC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:KOONTZ
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 1:3031 S ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3201
Mailing Address - Country:US
Mailing Address - Phone:719-392-1218
Mailing Address - Fax:719-392-0732
Practice Address - Street 1:3031 S ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3201
Practice Address - Country:US
Practice Address - Phone:719-392-1218
Practice Address - Fax:719-392-0732
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor