Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH3403 | FL |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | JE004022 | MI |
NPI | 1609900802 |
---|---|
Provider Name | Dr. Jeffrey Louis Eisman |
First Address | Detroit, MI 48235 |
Second Address | Detroit, MI 48235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 23/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1348177 | (05) | MI |
95OH222000 | BCBS (01) | MI |
U28841 | (02) | MI |