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General NPI Number Information
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NPI Number | 1861565814
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Entity Type | Organization
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Legal Business Name | JACQUETTE CHIROPRACTIC SC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/21/2009
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Provider Practice Location Address
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Address Line | 13740 W CAPITOL DR
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City | BROOKFIELD
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State | WI
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Zip | 53005-2407
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Country | US
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Telephone | 262-781-3332
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Fax | 262-781-6477
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Provider Business Mailing Address
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Address Line | 13740 W CAPITOL DR
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City | BROOKFIELD
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State | WI
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Zip | 53005-2407
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Country | US
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Telephone | 262-781-3332
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Fax | 262-781-6477
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK R JACQUETTE
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Credential | D.C.
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Telephone | 262-781-3332
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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 |
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License Number State | WI
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