Individual
JONATHAN ILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2350 17TH AVE, SUITE 105, LONGMONT, CO 80503-1737
(303) 651-7003
Mailing address
2350 17TH AVE, SUITE 105, LONGMONT, CO 80503-1737
(303) 651-7003
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6511
CO
Other
Enumeration date
04/02/2010
Last updated
07/24/2014
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