Provider Demographics
NPI:1093829129
Name:CONNORS, JEFFREY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:CONNORS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:973 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2926
Mailing Address - Country:US
Mailing Address - Phone:817-431-2184
Mailing Address - Fax:817-428-4436
Practice Address - Street 1:1304 GLADE RD
Practice Address - Street 2:STE. 200
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4287
Practice Address - Country:US
Practice Address - Phone:817-426-7346
Practice Address - Fax:817-428-4436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU63456Medicare UPIN