Healthcare Provider Details

I. General information

NPI: 1982867925
Provider Name (Legal Business Name): JACCARD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MARKET STREET SUITE B
LA CYGNE KS
66040-9998
US

IV. Provider business mailing address

1212 STARBROOKE DR
LOUISBURG KS
66053-4142
US

V. Phone/Fax

Practice location:
  • Phone: 913-709-2364
  • Fax:
Mailing address:
  • Phone: 913-709-2364
  • Fax: 913-681-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5141
License Number StateKS

VIII. Authorized Official

Name: DR. LINDSEY JACCARD
Title or Position: OWNER
Credential: D.C.
Phone: 913-709-2364