Provider Demographics
NPI:1720128135
Name:DEVINE, JEFFREY (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DEVINE
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 1:213 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MN
Mailing Address - Zip Code:55972-1403
Mailing Address - Country:US
Mailing Address - Phone:507-932-5696
Mailing Address - Fax:
Practice Address - Street 1:213 E 6TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MN
Practice Address - Zip Code:55972-1403
Practice Address - Country:US
Practice Address - Phone:507-932-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor