Provider Demographics
NPI:1376772525
Name:MCINTYRE, JEFFREY R (D C)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:MCINTYRE
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 1:407 E MARKET ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1852
Mailing Address - Country:US
Mailing Address - Phone:765-362-1500
Mailing Address - Fax:765-361-8919
Practice Address - Street 1:1541 S SCATTERFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5784
Practice Address - Country:US
Practice Address - Phone:765-649-1991
Practice Address - Fax:765-649-3383
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002470A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200959690Medicaid
IN000000729295OtherANTHEM INDIVIDUAL PIN
INM400055076OtherMEDICARE PTAN INDIVIDUAL
IN200959690Medicaid
IN742130Medicare PIN
IN000000729294OtherANTHEM GROUP PIN
INM100055068OtherMEDICARE PTAN GROUP