MEDICARE: JEFFCO MANAGEMENT, LLC

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	6473	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	609220-01	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1538105051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFCO MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	10221 DESERT SANDS ST
Second Line	:	SUITE 206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-3959
Country	:	US
Telephone Number	:	210-738-0771
Fax Number	:	210-342-1004

Provider Business Practice Location Address
First Line	:	10221 DESERT SANDS ST
Second Line	:	SUITE 206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-3959
Country	:	US
Telephone Number	:	210-738-0771
Fax Number	:	210-342-1004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY SCOTT REYNOLDS
Credential	:	D.C
Telephone Number	:	210-738-0771

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/22/2020

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