Provider Demographics
NPI:1609900802
Name:EISMAN, JEFFREY LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LOUIS
Last Name:EISMAN
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 1:17401 GREENFIELD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-837-3300
Mailing Address - Fax:313-837-5550
Practice Address - Street 1:17401 GREENFIELD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-837-3300
Practice Address - Fax:313-837-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJE004022111NX0800X
FLCH3403111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OH222000OtherBCBS
MI1348177Medicaid
MI1348177Medicaid
MI0H28058002Medicare PIN