Basic Information
| Provider Information | |||||||||
| NPI: | 1831185818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIE | ||||||||
| FirstName: | JEFF | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 916 TALON DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622691848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186288211 | ||||||||
| FaxNumber: | 6186280883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 S STATE ROUTE 157 | ||||||||
| Address2: | SUITE 200C | ||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182884100 | ||||||||
| FaxNumber: | 6183073283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CE006572 | MO | N | Chiropractic Providers | Chiropractor | 111N00000X | 038011166 | IL | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 900068033 | 01 | IL | ESSENCE | OTHER | 900068033 | 01 | IL | BCBS | OTHER | 900068033 | 01 | IL | HEALTHLINK | OTHER |