Healthcare Provider Details

I. General information

NPI: 1730214446
Provider Name (Legal Business Name): JEFFREY ALLEN MIDDLETON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SW 3RD AVE
POMPANO BEACH FL
33060-8384
US

IV. Provider business mailing address

661 SW 3RD AVE
POMPANO BEACH FL
33060-8384
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-3685
  • Fax: 954-771-3685
Mailing address:
  • Phone: 954-771-3685
  • Fax: 954-771-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH6493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: