Provider Demographics
NPI:1881943439
Name:GARGUS, JEFFREY ALAN JR (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:GARGUS
Suffix:JR
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 1:6521 HIGHWAY 69 S
Mailing Address - Street 2:SUITE N
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6498
Mailing Address - Country:US
Mailing Address - Phone:205-345-5035
Mailing Address - Fax:205-345-5034
Practice Address - Street 1:6521 HIGHWAY 69 S
Practice Address - Street 2:SUITE N
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6498
Practice Address - Country:US
Practice Address - Phone:205-345-5035
Practice Address - Fax:205-345-5034
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor