Provider Demographics
NPI:1053339721
Name:PLOTKIN, JEFFREY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:PLOTKIN
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 1:8111 CANOGA AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-4103
Mailing Address - Country:US
Mailing Address - Phone:818-887-0651
Mailing Address - Fax:818-887-5620
Practice Address - Street 1:8111 CANOGA AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-4103
Practice Address - Country:US
Practice Address - Phone:818-887-0651
Practice Address - Fax:818-887-5620
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0204850OtherBLUE SHIELD PROVIDER NO.
CADC21473BMedicare ID - Type Unspecified