Provider Demographics
NPI:1194806935
Name:JEFFERS, KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:JEFFERS
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 1:7770 REGENTS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1937
Mailing Address - Country:US
Mailing Address - Phone:858-452-7770
Mailing Address - Fax:858-452-0027
Practice Address - Street 1:7770 REGENTS RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1937
Practice Address - Country:US
Practice Address - Phone:858-452-7770
Practice Address - Fax:858-452-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16428111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06137Medicare UPIN
CADC16428Medicare ID - Type Unspecified