Provider Demographics
NPI:1942293378
Name:JERNBERG, JEFFREY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:JERNBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:MICHAEL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4281 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4625
Mailing Address - Country:US
Mailing Address - Phone:712-274-6695
Mailing Address - Fax:712-274-6699
Practice Address - Street 1:4281 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4625
Practice Address - Country:US
Practice Address - Phone:712-274-6695
Practice Address - Fax:712-274-6699
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09074OtherBLUE CROSS BLUE SHIELD
IA020611Medicaid