Provider Demographics
NPI:1528023454
Name:LIMONOFF, JEFFREY HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HAROLD
Last Name:LIMONOFF
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 1:3816 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-9534
Mailing Address - Country:US
Mailing Address - Phone:517-223-8962
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD
Practice Address - Street 2:STE A105
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8445
Practice Address - Country:US
Practice Address - Phone:517-336-7711
Practice Address - Fax:517-336-7737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2788885Medicaid
MI0P09900Medicare ID - Type Unspecified
MI2788885Medicaid