Provider Demographics
NPI:1861411233
Name:DRAKE, JEFF L (DC)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:L
Last Name:DRAKE
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 1:154 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1152
Mailing Address - Country:US
Mailing Address - Phone:316-651-0156
Mailing Address - Fax:316-684-2225
Practice Address - Street 1:154 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1152
Practice Address - Country:US
Practice Address - Phone:316-651-0156
Practice Address - Fax:316-684-2225
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS55866OtherBCBS OF KS
KS55866OtherBCBS OF KS
KST43942Medicare UPIN