Provider Demographics
NPI:1912072869
Name:FORD, JEFFERY D (DC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:FORD
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:PO BOX 149
Mailing Address - Street 2:1 JAMES ST
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-0149
Mailing Address - Country:US
Mailing Address - Phone:315-298-4399
Mailing Address - Fax:315-298-4399
Practice Address - Street 1:1 JAMES ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142
Practice Address - Country:US
Practice Address - Phone:315-298-4399
Practice Address - Fax:315-298-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0047031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000013786OtherBLUE CROSS BLUE SHIELD
0012404OtherGHI
4583537OtherAETNA
NY514798Medicare ID - Type Unspecified