MEDICARE: DR. JEFFREY CHARLES EIDSVIG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AW433	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1316133838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CHARLES EIDSVIG D.C.

Provider Business Mailing Address
First Line	:	3060 COMMUNICATIONS PARKWAY
Second Line	:	#104
City	:	PLANO
State	:	TX
Zip	:	75093
Country	:	US
Telephone Number	:	972-312-9310
Fax Number	:	972-312-9316

Provider Business Practice Location Address
First Line	:	5944 W PARKER RD
Second Line	:	#400
City	:	PLANO
State	:	TX
Zip	:	75093-6421
Country	:	US
Telephone Number	:	972-309-2021
Fax Number	:	972-309-2023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	03/31/2016

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