Healthcare Provider Details

I. General information

NPI: 1689502718
Provider Name (Legal Business Name): JACE BANKORD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N STATE ST
MARENGO IL
60152-2217
US

IV. Provider business mailing address

111 N STATE ST
MARENGO IL
60152-2217
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-9900
  • Fax:
Mailing address:
  • Phone: 815-568-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: