Provider Demographics
NPI:1902930043
Name:KOFFEMAN, JAMES G (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:KOFFEMAN
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 1:203 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2011
Mailing Address - Country:US
Mailing Address - Phone:517-780-4045
Mailing Address - Fax:
Practice Address - Street 1:203 S WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2011
Practice Address - Country:US
Practice Address - Phone:517-780-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK007516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM58280Medicare ID - Type Unspecified
MIU71065Medicare UPIN