Provider Demographics
NPI:1578627352
Name:JEFFCO MANAGEMENT LLC
Entity Type:Organization
Organization Name:JEFFCO MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-738-0771
Mailing Address - Street 1:10221 DESERT SANDS ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3944
Mailing Address - Country:US
Mailing Address - Phone:210-738-0771
Mailing Address - Fax:210-342-1004
Practice Address - Street 1:10221 DESERT SANDS ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3944
Practice Address - Country:US
Practice Address - Phone:210-738-0771
Practice Address - Fax:210-342-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187957901Medicaid
TX8W1320OtherBCBS
TX8W1320OtherBCBS
TX187957901Medicaid