Provider Demographics
NPI:1972512093
Name:SPINA, JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SPINA
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-0490
Mailing Address - Country:US
Mailing Address - Phone:845-342-0746
Mailing Address - Fax:845-342-2739
Practice Address - Street 1:52 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6424
Practice Address - Country:US
Practice Address - Phone:845-342-0746
Practice Address - Fax:845-342-2739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX62411Medicare ID - Type UnspecifiedMEDICARE ID NUMBER