Provider Demographics
NPI:1407950868
Name:TABOR, JEFF O (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:O
Last Name:TABOR
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 1:923 N SHIPP STREET
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240
Mailing Address - Country:US
Mailing Address - Phone:505-397-7323
Mailing Address - Fax:505-397-7323
Practice Address - Street 1:923 N SHIPP STREET
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-397-7323
Practice Address - Fax:505-397-7323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK635OtherBCBS
NM5961356OtherAETNA
NMK635OtherBCBS
NM5961356OtherAETNA