Provider Demographics
NPI:1952165573
Name:JIREH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JIREH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-318-9797
Mailing Address - Street 1:1822 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2921
Mailing Address - Country:US
Mailing Address - Phone:765-318-9797
Mailing Address - Fax:
Practice Address - Street 1:1822 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2921
Practice Address - Country:US
Practice Address - Phone:765-318-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty