Provider Demographics
NPI:1184956583
Name:STANDISH, JEFFREY HUNTER
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HUNTER
Last Name:STANDISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 KIRKVILLE RD
Mailing Address - Street 2:2A
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-437-1600
Mailing Address - Fax:315-437-1900
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:2A
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-437-1600
Practice Address - Fax:315-437-1900
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor