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NPI Code Detail

MEDICARE: MR. JACK B. FOUGHTY D.C.

MEDICARE: MR. JACK B. FOUGHTY 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
1111N00000XChiropractor850OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538221445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACK B. FOUGHTY D.C.
Provider Business Mailing Address
First Line : 6822 WHIPPLE AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-7336
Country : US
Telephone Number : 330-499-0147
Fax Number : 330-499-8148
Provider Business Practice Location Address
First Line : 6822 WHIPPLE AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-7336
Country : US
Telephone Number : 330-499-0147
Fax Number : 330-499-8148
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 10/11/2011

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