Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC16428 | CA |
NPI | 1194806935 |
---|---|
Provider Name | Dr. Keith Jeffers |
First Address | San Diego, CA 92122-1937 |
Second Address | San Diego, CA 92122-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T06137 | (02) | CA |