Provider Demographics
NPI:1073507950
Name:GIVEN, JEFFREY BRYAN (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRYAN
Last Name:GIVEN
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 1:3857 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9480
Mailing Address - Country:US
Mailing Address - Phone:304-757-7266
Mailing Address - Fax:304-757-9865
Practice Address - Street 1:3857 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9480
Practice Address - Country:US
Practice Address - Phone:304-757-7266
Practice Address - Fax:304-757-9865
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131430000Medicaid
WV0131430000Medicaid
0581912Medicare ID - Type Unspecified