Healthcare Provider Details

I. General information

NPI: 1821051699
Provider Name (Legal Business Name): JACK L. EPTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W INDIANTOWN RD
JUPITER FL
33458-3530
US

IV. Provider business mailing address

100 W INDIANTOWN RD
JUPITER FL
33458-3530
US

V. Phone/Fax

Practice location:
  • Phone: 561-575-4400
  • Fax: 561-427-0026
Mailing address:
  • Phone: 561-575-4400
  • Fax: 561-427-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH0004296
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX3467
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3443
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH0004296
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX3467
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3443
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: