Provider Demographics
NPI:1952519571
Name:JEFFREY, ROBERT I (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5106
Mailing Address - Country:US
Mailing Address - Phone:310-826-5151
Mailing Address - Fax:310-826-8446
Practice Address - Street 1:11611 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5106
Practice Address - Country:US
Practice Address - Phone:310-826-5151
Practice Address - Fax:310-826-8446
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20636111N00000X
CAAC 4833171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist