Provider Demographics
NPI:1306146741
Name:WHITFIELD, JEREMY M (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:WHITFIELD
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 1:100 HOPE ST.
Mailing Address - Street 2:UNIT 26
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906
Mailing Address - Country:US
Mailing Address - Phone:845-612-3074
Mailing Address - Fax:
Practice Address - Street 1:100 HOPE ST.
Practice Address - Street 2:UNIT 26
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906
Practice Address - Country:US
Practice Address - Phone:845-612-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009699111N00000X
CT001456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor