Provider Demographics
NPI:1326071150
Name:COLE, JEFFREY LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANE
Last Name:COLE
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 1:207 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055
Mailing Address - Country:US
Mailing Address - Phone:256-734-6813
Mailing Address - Fax:256-734-6880
Practice Address - Street 1:207 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3609
Practice Address - Country:US
Practice Address - Phone:256-734-6813
Practice Address - Fax:256-734-6880
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517844OtherBLUE CROSS BLUE SHIELD
AL051517844Medicare ID - Type Unspecified
ALL270Medicare PIN
ALD530Medicare PIN
ALU97497Medicare UPIN