MEDICARE: JEFF EIDSVIG D.C., PLLC

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	261Q00000X	Clinic/Center	10334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0088RA	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1518149111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF EIDSVIG D.C., PLLC

Provider Business Mailing 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

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	:	OWNER
Name	:	DR. JEFF C EIDSVIG
Credential	:	D.C.
Telephone Number	:	972-309-2021

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	10/23/2008

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