Individual
JACOB THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 WEAVER PARK RD, LONGMONT, CO 80501-6000
(360) 513-8579
Mailing address
1454 ALPINE ST, LONGMONT, CO 80504-3062
Taxonomy
Speciality
Code
Description
License number
State
332U00000X
Home Delivered Meals
Primary
46-5233699
CO
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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