Healthcare Provider Details

I. General information

NPI: 1902930043
Provider Name (Legal Business Name): JAMES G KOFFEMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WEST AVE
JACKSON MI
49201-2011
US

IV. Provider business mailing address

203 S WEST AVE
JACKSON MI
49201-2011
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-4045
  • Fax:
Mailing address:
  • Phone: 517-780-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberJK007516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: