Provider Demographics
NPI:1972790772
Name:JEFFERY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:JEFFERY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-593-0999
Mailing Address - Street 1:1037 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2805
Mailing Address - Country:US
Mailing Address - Phone:801-593-0999
Mailing Address - Fax:801-513-5056
Practice Address - Street 1:1037 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2805
Practice Address - Country:US
Practice Address - Phone:801-593-0999
Practice Address - Fax:801-513-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294426-1202111N00000X
UT294425-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005761701Medicare PIN