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General NPI Number Information
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NPI Number | 1588772982
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Entity Type | Organization
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Legal Business Name | JACK HEASLET CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 1106 VINE STREET
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City | PASO ROBLES
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State | CA
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Zip | 93446-2596
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Country | US
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Telephone | 805-237-7380
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Fax | 805-237-1302
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Provider Business Mailing Address
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Address Line | 1106 VINE ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2576
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Country | US
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Telephone | 805-237-7380
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Fax | 805-237-1302
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Authorized Official
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Title or Position | CEO
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Name | MR. JACK EDWARD HEASLET
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Credential | DC
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Telephone | 805-237-7380
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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 | DC29974
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License Number State | CA
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