Provider Demographics
NPI:1518149111
Name:JEFF EIDSVIG D.C., PLLC
Entity Type:Organization
Organization Name:JEFF EIDSVIG D.C., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:C
Authorized Official - Last Name:EIDSVIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-309-2021
Mailing Address - Street 1:5944 W PARKER RD
Mailing Address - Street 2:#400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6421
Mailing Address - Country:US
Mailing Address - Phone:972-309-2021
Mailing Address - Fax:972-309-2023
Practice Address - Street 1:5944 W PARKER RD
Practice Address - Street 2:400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6421
Practice Address - Country:US
Practice Address - Phone:972-309-2021
Practice Address - Fax:972-309-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10334261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0088RAOtherBCBS
TX0088RAOtherBCBS