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Individual

CASEY RYKO JESTROVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CNIM, R. EEG T

Contact information

Practice address
2318 HALL AVE, GRAND JUNCTION, CO 81501-6234
(303) 886-6641
Mailing address
2318 HALL AVE, GRAND JUNCTION, CO 81501-6234
(303) 886-6641

Taxonomy

Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
99-187-0511
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
VAD450M96159
ANTHEM BLUE CROSS/BLUE SHIELD
CO
Enumeration date
10/23/2018
Last updated
10/23/2018
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