Provider Demographics
NPI:1851539845
Name:PRIEBE, JEFF J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:J
Last Name:PRIEBE
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 1:8109 N WAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5031
Mailing Address - Country:US
Mailing Address - Phone:208-762-6384
Mailing Address - Fax:208-762-6385
Practice Address - Street 1:8109 N WAYNE BLVD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5031
Practice Address - Country:US
Practice Address - Phone:208-762-6384
Practice Address - Fax:208-762-6385
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1531111N00000X
IDCHIA-1351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor