Provider Demographics
NPI:1699306969
Name:KIRKLAND, JEFFERY WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:WILLIAM
Last Name:KIRKLAND
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 1:10628 STATE HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-5597
Mailing Address - Country:US
Mailing Address - Phone:903-286-2095
Mailing Address - Fax:
Practice Address - Street 1:6004 S BROADWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4424
Practice Address - Country:US
Practice Address - Phone:903-534-7095
Practice Address - Fax:903-534-7094
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor