Provider Demographics
NPI:1508870973
Name:KATZ, JEFFREY L (DC OME)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:KATZ
Suffix:
Gender:M
Credentials:DC OME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-584-3042
Mailing Address - Fax:415-584-3052
Practice Address - Street 1:4879 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-584-3042
Practice Address - Fax:415-584-3052
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05459Medicare UPIN
CAZZZ07985ZMedicare ID - Type Unspecified