Provider Demographics
NPI:1689615304
Name:COTTINGHAM, JEFF (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:COTTINGHAM
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 1:5055 W RAY RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6108
Mailing Address - Country:US
Mailing Address - Phone:480-940-4880
Mailing Address - Fax:480-940-4809
Practice Address - Street 1:5055 W RAY RD
Practice Address - Street 2:SUITE 21
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6108
Practice Address - Country:US
Practice Address - Phone:480-940-4880
Practice Address - Fax:480-940-4809
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5530/3186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860945080OtherTAX ID #
AZ0930200OtherBCBS ARIZONA
AZ0930200OtherBCBS ARIZONA