Provider Demographics
NPI:1942226048
Name:RADA, JENNIFER LINN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LINN
Last Name:RADA
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 1:13131 W ALAMEDA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3108
Mailing Address - Country:US
Mailing Address - Phone:720-597-3818
Mailing Address - Fax:
Practice Address - Street 1:13131 W ALAMEDA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3108
Practice Address - Country:US
Practice Address - Phone:720-597-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3703-012111N00000X
CO007287111N00000X
CO0007287111N00000X
CO7287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU82031Medicaid
CO0007287OtherCOLORADO
WI38927900Medicaid
U82031Medicare UPIN