Provider Demographics
NPI:1922231638
Name:DRAESEL, JEFFREY GLEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLEN
Last Name:DRAESEL
Suffix:JR
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 1:1108 KANE CONCOURSE STE 300B
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2068
Mailing Address - Country:US
Mailing Address - Phone:305-866-3780
Mailing Address - Fax:305-868-3124
Practice Address - Street 1:1108 KANE CONCOURSE STE 300B
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2068
Practice Address - Country:US
Practice Address - Phone:305-866-3780
Practice Address - Fax:305-868-3124
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor