Healthcare Provider Details

I. General information

NPI: 1750334686
Provider Name (Legal Business Name): JEFFREY D LUEBBE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 SUMMER OAKS DR
BARTLETT TN
38134-3812
US

IV. Provider business mailing address

2845 SUMMER OAKS DR
BARTLETT TN
38134-3812
US

V. Phone/Fax

Practice location:
  • Phone: 901-377-2340
  • Fax: 901-373-4570
Mailing address:
  • Phone: 901-377-2340
  • Fax: 901-373-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC457
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: