Provider Demographics
NPI:1821233933
Name:JEFFRIES, FRANK WALLACE IV (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:WALLACE
Last Name:JEFFRIES
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:WALLACE
Other - Last Name:JEFFRIES
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:708 CHIPPEWA SQUARE
Mailing Address - Street 2:#5
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-226-7525
Mailing Address - Fax:906-226-7525
Practice Address - Street 1:708 CHIPPEWA SQ
Practice Address - Street 2:#5
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-226-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007181111N00000X
SC2746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE25005OtherBXBS