Provider Demographics
NPI:1427040690
Name:MONNIN, JEFFRY GERARD (DC)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:GERARD
Last Name:MONNIN
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 1:430 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1104
Mailing Address - Country:US
Mailing Address - Phone:937-498-4052
Mailing Address - Fax:937-497-0371
Practice Address - Street 1:430 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1104
Practice Address - Country:US
Practice Address - Phone:937-498-4052
Practice Address - Fax:937-497-0371
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM00612781Medicare ID - Type Unspecified
T48765Medicare UPIN