Provider Demographics
NPI:1306802525
Name:POFF, DOUGLAS JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JEFFREY
Last Name:POFF
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 1:500 PACIFIC COAST HWY
Mailing Address - Street 2:210B
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5993
Mailing Address - Country:US
Mailing Address - Phone:562-431-6688
Mailing Address - Fax:
Practice Address - Street 1:500 PACIFIC COAST HWY
Practice Address - Street 2:210B
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5993
Practice Address - Country:US
Practice Address - Phone:562-431-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18345Medicare UPIN
CADC16482Medicare ID - Type UnspecifiedMEDICARE NUMBER