Provider Demographics
NPI:1982964201
Name:FAVERO, JEFFREY ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:FAVERO
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 1:365 E LOMOND VIEW DR # 102
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2269
Mailing Address - Country:US
Mailing Address - Phone:801-784-6306
Mailing Address - Fax:801-784-6316
Practice Address - Street 1:365 E LOMOND VIEW DR # 102
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2269
Practice Address - Country:US
Practice Address - Phone:801-784-6306
Practice Address - Fax:801-784-6316
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8317619-1202111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor