Provider Demographics
NPI:1316939119
Name:MACKEY, JEFFREY C (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:MACKEY
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 1:3205 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4332
Mailing Address - Country:US
Mailing Address - Phone:608-249-7657
Mailing Address - Fax:608-249-7728
Practice Address - Street 1:3205 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4332
Practice Address - Country:US
Practice Address - Phone:608-249-7657
Practice Address - Fax:608-249-7728
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1576111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38764300Medicaid
WI38764300Medicaid
WI000635155Medicare ID - Type Unspecified