Provider Demographics
NPI:1831185818
Name:DAVIE, JEFF LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:LEE
Last Name:DAVIE
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 1:916 TALON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:618-628-8211
Mailing Address - Fax:618-628-0883
Practice Address - Street 1:1181 S STATE ROUTE 157
Practice Address - Street 2:SUITE 200C
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3710
Practice Address - Country:US
Practice Address - Phone:618-288-4100
Practice Address - Fax:618-307-3283
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006572111N00000X
IL038011166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900068033OtherESSENCE
IL900068033OtherBCBS
IL900068033OtherHEALTHLINK
IL900068033OtherESSENCE
IL900068033OtherHEALTHLINK