Provider Demographics
NPI:1386397107
Name:CASAGRANDE, JEREMY JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JUSTIN
Last Name:CASAGRANDE
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 1:12412 YORK ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2741
Mailing Address - Country:US
Mailing Address - Phone:855-640-0481
Mailing Address - Fax:
Practice Address - Street 1:12412 YORK ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2741
Practice Address - Country:US
Practice Address - Phone:855-640-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13290111N00000X
COCHR.0005693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor