Provider Demographics
NPI:1689875684
Name:MOLLINS, JEFF J (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:J
Last Name:MOLLINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:#920
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-802-0800
Mailing Address - Fax:718-625-4459
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:#920
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-802-0800
Practice Address - Fax:718-625-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX035412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX19311Medicare ID - Type Unspecified