Provider Demographics
NPI:1801017371
Name:CHAMBERLAIN, JEFFREY C (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:CHAMBERLAIN
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 1:1223 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5686
Mailing Address - Country:US
Mailing Address - Phone:610-429-4920
Mailing Address - Fax:610-429-0848
Practice Address - Street 1:1223 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5686
Practice Address - Country:US
Practice Address - Phone:610-429-4920
Practice Address - Fax:610-429-0848
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004938L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2102996000OtherKEYSTONE
PA1412495OtherHIGHMARK
PA2102996000OtherKEYSTONE
PA720331Medicare ID - Type Unspecified