Provider Demographics
NPI:1568665990
Name:JEFFREY D. LAUFENBERG D.C., P.C.
Entity type:Organization
Organization Name:JEFFREY D. LAUFENBERG D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAUFENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-873-4444
Mailing Address - Street 1:6611 W PEORIA AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-7000
Mailing Address - Country:US
Mailing Address - Phone:623-873-4444
Mailing Address - Fax:
Practice Address - Street 1:6611 W PEORIA AVE
Practice Address - Street 2:STE. 3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7000
Practice Address - Country:US
Practice Address - Phone:623-873-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ949539Medicaid
AZZ74555Medicare PIN
AZ949539Medicaid