Provider Demographics
NPI:1154337897
Name:WEST, JEFFREY J (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:WEST
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 1:218 E MAIN ST
Mailing Address - Street 2:STE 112
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7364
Mailing Address - Country:US
Mailing Address - Phone:302-832-7000
Mailing Address - Fax:302-832-7801
Practice Address - Street 1:218 E MAIN ST
Practice Address - Street 2:STE 112
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7364
Practice Address - Country:US
Practice Address - Phone:302-525-4343
Practice Address - Fax:302-266-0450
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01264OtherMEDICARE GROUP
DE72-1564372OtherTAX ID #
DEG01264Medicare PIN
DEB929T64Medicare UPIN
DE00B929T64Medicare PIN