Provider Demographics
NPI:1659594091
Name:KASBAUM, JEFFREY BRECKENRIDGE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRECKENRIDGE
Last Name:KASBAUM
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 1:5401 S SHERIDAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7531
Mailing Address - Country:US
Mailing Address - Phone:918-270-7221
Mailing Address - Fax:918-494-7983
Practice Address - Street 1:5401 S SHERIDAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-7531
Practice Address - Country:US
Practice Address - Phone:918-270-7221
Practice Address - Fax:918-494-7983
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor