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General NPI Number Information
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NPI Number | 1780696658
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Entity Type | Individual
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Provider Name | JEFFREY D PORTER D.O
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 919 N DYSART RD
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City | AVONDALE
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State | AZ
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Zip | 85323-1711
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Country | US
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Telephone | 623-882-2121
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Fax | 623-882-2123
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Provider Business Mailing Address
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Address Line | 919 N DYSART RD
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City | AVONDALE
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State | AZ
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Zip | 85323-1711
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Country | US
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Telephone | 623-882-2121
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Fax | 623-882-2123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7252
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License Number State | AZ
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