Provider Demographics
NPI:1144603143
Name:EYERLY, JEFFREY M (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:EYERLY
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 1:502 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7902
Mailing Address - Country:US
Mailing Address - Phone:570-262-0001
Mailing Address - Fax:
Practice Address - Street 1:401 VENTURE DR STE C
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3475
Practice Address - Country:US
Practice Address - Phone:570-262-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011047111N00000X
FLCH12254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor