Healthcare Provider Details

I. General information

NPI: 1144792524
Provider Name (Legal Business Name): JACLYN HURLEY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2018
Last Update Date: 12/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 E CRESCENTVILLE RD
CINCINNATI OH
45246-4808
US

IV. Provider business mailing address

8039 CINCINNATI DAYTON RD
WEST CHESTER OH
45069-2004
US

V. Phone/Fax

Practice location:
  • Phone: 859-250-4067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-04809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: