Provider Demographics
NPI:1558425306
Name:JEX, JEFF H (DC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:H
Last Name:JEX
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 1:1439 E GOLDCREST ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-4604
Mailing Address - Country:US
Mailing Address - Phone:480-543-0106
Mailing Address - Fax:
Practice Address - Street 1:1946 S SIGNAL BUTTE RD
Practice Address - Street 2:SUITE A105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2732
Practice Address - Country:US
Practice Address - Phone:480-857-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5157401-1202111N00000X
AZ7968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056383Medicare ID - Type UnspecifiedCHIROPRACTOR
UTU96730Medicare UPIN