Provider Demographics
NPI:1104040799
Name:THURMOND, JEB ROBERTSON (DC)
Entity Type:Individual
Prefix:
First Name:JEB
Middle Name:ROBERTSON
Last Name:THURMOND
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 1:640 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4049
Mailing Address - Country:US
Mailing Address - Phone:603-313-0617
Mailing Address - Fax:855-461-3277
Practice Address - Street 1:640 MARLBORO ST STE 1
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4049
Practice Address - Country:US
Practice Address - Phone:603-313-0617
Practice Address - Fax:855-461-3277
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH180-0494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39353Medicare UPIN
RE3195Medicare ID - Type Unspecified