Healthcare Provider Details

I. General information

NPI: 1912102021
Provider Name (Legal Business Name): JACK CACIC AND COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N H ST
LAKE WORTH FL
33460-3701
US

IV. Provider business mailing address

17 N H ST
LAKE WORTH FL
33460-3701
US

V. Phone/Fax

Practice location:
  • Phone: 561-547-2210
  • Fax: 561-547-2210
Mailing address:
  • Phone: 561-547-2210
  • Fax: 561-547-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH7724
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH7724
License Number StateFL

VIII. Authorized Official

Name: DR. JACK JOSEPH CACIC
Title or Position: PRESIDENT OWNER
Credential: D.C.
Phone: 561-547-2210