Provider Demographics
NPI:1891726196
Name:COFFEY, JENNIFER VICTORIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S DAISY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4333
Mailing Address - Country:US
Mailing Address - Phone:208-756-2202
Mailing Address - Fax:208-756-2213
Practice Address - Street 1:104 S DAISY ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4333
Practice Address - Country:US
Practice Address - Phone:208-756-2202
Practice Address - Fax:208-756-2213
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor