Provider Demographics
NPI:1013957984
Name:JEFFERS, THOMAS P (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:JEFFERS
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROBERTS LANE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:570-296-4455
Mailing Address - Fax:570-296-9682
Practice Address - Street 1:101 ROBERTS LANE
Practice Address - Street 2:SUITE 1B
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337
Practice Address - Country:US
Practice Address - Phone:570-296-4455
Practice Address - Fax:570-296-9682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005220L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015640300001Medicaid
PA056033Medicare ID - Type Unspecified
PA1015640300001Medicaid