=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588724926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY F KIEFFER DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 06/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 667 OLD HIGHWAY 30
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-4804
-----------------------------------------------------
Fax | 208-587-4889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 667 OLD HIGHWAY 30
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-4804
-----------------------------------------------------
Fax | 208-587-4889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIA567
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------