MEDICARE: DR. ONDRE M. JACQUES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008019	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F325190	OTHER		BCBSM

General Provider Information

NPI Number	:	1487873071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ONDRE M. JACQUES D.C.

Provider Business Mailing Address
First Line	:	555 BARCLAY CIR STE 140
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4587
Country	:	US
Telephone Number	:	248-299-6911
Fax Number	:	248-299-6915

Provider Business Practice Location Address
First Line	:	555 BARCLAY CIR STE 140
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4587
Country	:	US
Telephone Number	:	248-299-6911
Fax Number	:	248-299-6915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/19/2022

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