Provider Demographics
NPI:1902817729
Name:NOAH, JEFFREY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:NOAH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SO CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:336-229-1861
Mailing Address - Fax:336-229-9670
Practice Address - Street 1:1210 SO CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-229-1861
Practice Address - Fax:336-229-9670
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244454Medicare ID - Type Unspecified
T64484Medicare UPIN