Provider Demographics
NPI:1215028592
Name:DETTWILER, JEFFREY DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:DETTWILER
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 1:9865 E 116TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9239
Mailing Address - Country:US
Mailing Address - Phone:317-902-5802
Mailing Address - Fax:
Practice Address - Street 1:9865 E 116TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9231
Practice Address - Country:US
Practice Address - Phone:317-902-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002271A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor