Provider Demographics
NPI:1265496475
Name:ALBRO, JEB R (DC)
Entity Type:Individual
Prefix:DR
First Name:JEB
Middle Name:R
Last Name:ALBRO
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 1:57 TROY ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1105
Mailing Address - Country:US
Mailing Address - Phone:315-568-0114
Mailing Address - Fax:
Practice Address - Street 1:225B BORDER CITY RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1971
Practice Address - Country:US
Practice Address - Phone:315-781-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU96745Medicare UPIN
NYDD6956Medicare ID - Type UnspecifiedCHIROPRACTOR