Provider Demographics
NPI:1134112063
Name:JEFFRIES, JOSEPH M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:JEFFRIES
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 1:3424 E EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1302
Mailing Address - Country:US
Mailing Address - Phone:859-273-3501
Mailing Address - Fax:
Practice Address - Street 1:994 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2308
Practice Address - Country:US
Practice Address - Phone:859-887-4900
Practice Address - Fax:859-887-4995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85900124Medicaid
U73967Medicare UPIN
KY6093501Medicare ID - Type Unspecified