Provider Demographics
NPI:1548330640
Name:DEMKO, JEFFREY P (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:DEMKO
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 1:6908 W 200 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-9734
Mailing Address - Country:US
Mailing Address - Phone:219-921-2095
Mailing Address - Fax:
Practice Address - Street 1:810 MICHAEL DR STE E
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2695
Practice Address - Country:US
Practice Address - Phone:219-921-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000953A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN656930AMedicare ID - Type Unspecified
INT34997Medicare UPIN