Provider Demographics
NPI:1114415171
Name:PRINCE, JEFFREY DARIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DARIN
Last Name:PRINCE
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 1:8475 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2862
Mailing Address - Country:US
Mailing Address - Phone:702-898-3311
Mailing Address - Fax:
Practice Address - Street 1:8475 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2862
Practice Address - Country:US
Practice Address - Phone:702-898-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV46-5010353OtherDOCTORS HEALTH NETWORK
NV454005603OtherMAXHEALTH CENTER