Provider Demographics
NPI:1245396654
Name:HOWARD, JEFF H (D C)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:H
Last Name:HOWARD
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 BEACH BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2822
Mailing Address - Country:US
Mailing Address - Phone:904-725-8111
Mailing Address - Fax:904-725-8297
Practice Address - Street 1:6929 BEACH BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2822
Practice Address - Country:US
Practice Address - Phone:904-725-8111
Practice Address - Fax:904-725-8297
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMC772.325-3111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050961200Medicaid
FL88221OtherBLUE CROSS BLUE SHIELD
FLCH0002925OtherFL LICENSE
FL350056098OtherRAILROAD MEDICARE
FL050961200Medicaid
59-1827233OtherEIN
FL050961200Medicaid