Provider Demographics
NPI:1063417376
Name:PAUL, JEFFREY R (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:PAUL
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 1:712 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1000
Mailing Address - Country:US
Mailing Address - Phone:419-629-4500
Mailing Address - Fax:419-629-4500
Practice Address - Street 1:712 E MONROE ST
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-1000
Practice Address - Country:US
Practice Address - Phone:419-629-4500
Practice Address - Fax:419-629-4500
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341872779-00OtherWORKERS COMPENSATION
OH000000207583OtherANTHEM BLUE CROSS BLUE SH
OH2079281Medicaid
OHPA0866581Medicare ID - Type Unspecified
OH341872779-00OtherWORKERS COMPENSATION