Provider Demographics
NPI:1710171236
Name:MICHAEL, JEFFERY CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:CHARLES
Last Name:MICHAEL
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 1:9956 N MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1077
Mailing Address - Country:US
Mailing Address - Phone:410-629-1845
Mailing Address - Fax:
Practice Address - Street 1:9956 N MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1077
Practice Address - Country:US
Practice Address - Phone:410-629-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor