Provider Demographics
NPI:1063457877
Name:LAMB, JEFFREY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:LAMB
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 1:4201 S NOLAND RD STE U
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7332
Mailing Address - Country:US
Mailing Address - Phone:816-478-6224
Mailing Address - Fax:816-478-3890
Practice Address - Street 1:4201 S NOLAND RD STE U
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7332
Practice Address - Country:US
Practice Address - Phone:816-478-6224
Practice Address - Fax:816-478-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32537016OtherBLUE CROSS BLUE SHIELD
MOU94384Medicare UPIN
MO000C287Medicare ID - Type Unspecified