Provider Demographics
NPI:1679604201
Name:JEFFRIES, ROBERT PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PATRICK
Last Name:JEFFRIES
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 1:1423 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2930
Mailing Address - Country:US
Mailing Address - Phone:740-435-9555
Mailing Address - Fax:740-435-9515
Practice Address - Street 1:1423 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2930
Practice Address - Country:US
Practice Address - Phone:740-435-9555
Practice Address - Fax:740-435-9515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000302270OtherBLUE CROSS PIN
OHP00014293OtherRRMC PIN
OH2385048Medicaid
OHP00014293OtherRRMC PIN
OH000000302270OtherBLUE CROSS PIN