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General NPI Number Information
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NPI Number | 1588663033
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Entity Type | Individual
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Provider Name | JACK ROBERT MCDERMOTT D.C., FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 4439 STATE ROUTE 159 STE 280
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-7502
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Country | US
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Telephone | 740-779-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 4439 STATE ROUTE 159 STE 280
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-7502
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Country | US
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Telephone | 740-779-7050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3416
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4768
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 971
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 14318
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License Number State | OH
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