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General NPI Number Information
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NPI Number | 1780887141
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Entity Type | Individual
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Provider Name | JESSE CRACKNELL D.C,
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 3615 HARDING AVE STE 202
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City | HONOLULU
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State | HI
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Zip | 96816-3760
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Country | US
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Telephone | 808-737-4325
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Fax | 808-737-4324
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Provider Business Mailing Address
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Address Line | 3427 WAIALAE AVE # 335
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City | HONOLULU
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State | HI
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Zip | 96816-2619
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Country | US
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Telephone | 808-737-4325
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Fax | 808-737-4324
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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 | DC-945
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License Number State | HI
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