Provider Demographics
NPI:1568609840
Name:KRAICHELY, JEFFREY PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PATRICK
Last Name:KRAICHELY
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 1:1240 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3148
Mailing Address - Country:US
Mailing Address - Phone:843-821-8787
Mailing Address - Fax:843-821-8799
Practice Address - Street 1:1240 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3148
Practice Address - Country:US
Practice Address - Phone:843-821-8787
Practice Address - Fax:843-821-8799
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6573111N00000X
SC3509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH614Medicaid
SCP00981658OtherMEDICARE RAILROAD
SCAA48369463Medicare PIN