Provider Demographics
NPI:1841484144
Name:BRITTAIN, JEFFREY DALE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DALE
Last Name:BRITTAIN
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 1:5311 KIRBY DR STE 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1339
Mailing Address - Country:US
Mailing Address - Phone:713-527-8844
Mailing Address - Fax:713-429-1937
Practice Address - Street 1:5311 KIRBY DRIVE
Practice Address - Street 2:SUITE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1339
Practice Address - Country:US
Practice Address - Phone:713-527-8844
Practice Address - Fax:713-429-1937
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603380Medicare PIN