MEDICARE: DR. JEFFERY KYLE CLIFTON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH11573	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033585823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY KYLE CLIFTON DC

Provider Business Mailing Address
First Line	:	201 S RIDGEWOOD AVE
Second Line	:	STE 11
City	:	EDGEWATER
State	:	FL
Zip	:	32132-1935
Country	:	US
Telephone Number	:	386-423-7575
Fax Number	:	386-426-8443

Provider Business Practice Location Address
First Line	:	1402 DUNLAWTON AVE STE 4D
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2918
Country	:	US
Telephone Number	:	386-760-6150
Fax Number	:	386-788-1998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2015
Last Update Date	:	11/27/2018

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