Provider Demographics
NPI:1861512576
Name:NAGLE, JEFFREY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:NAGLE
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 1:808 E WAKEFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5147
Mailing Address - Country:US
Mailing Address - Phone:573-472-4470
Mailing Address - Fax:573-472-4139
Practice Address - Street 1:808 E WAKEFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5147
Practice Address - Country:US
Practice Address - Phone:573-472-4470
Practice Address - Fax:573-472-4139
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5752111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
350025205OtherRR MEDICARE PALMENTO
MO44-01193OtherUNITED HEALT CARE
MO189386OtherHEALTHLINK
MO106378OtherBCBS
MO44-01193OtherUNITED HEALT CARE
U18887Medicare UPIN