Provider Demographics
NPI:1023507746
Name:COLEMAN, JEREMY LEUMUN, MARQUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LEUMUN, MARQUIS
Last Name:COLEMAN
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 1:5295 GALAXIE DR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4337
Mailing Address - Country:US
Mailing Address - Phone:601-214-3787
Mailing Address - Fax:
Practice Address - Street 1:5295 GALAXIE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4337
Practice Address - Country:US
Practice Address - Phone:601-214-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor