Provider Demographics
NPI:1316133838
Name:EIDSVIG, JEFFREY CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:EIDSVIG
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:3060 COMMUNICATIONS PARKWAY
Mailing Address - Street 2:#104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-312-9310
Mailing Address - Fax:972-312-9316
Practice Address - Street 1:5944 W PARKER RD
Practice Address - Street 2:#400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6421
Practice Address - Country:US
Practice Address - Phone:972-309-2021
Practice Address - Fax:972-309-2023
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2016-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX10334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW433OtherBCBS
TX8F8563Medicare PIN