MEDICARE: JACK M ALLOY DC

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	3461	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1720143837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK M ALLOY DC

Provider Business Mailing Address
First Line	:	632 SWAN DR
Second Line	:
City	:	WATERFORD
State	:	WI
Zip	:	53185-2882
Country	:	US
Telephone Number	:	262-514-4470
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W BLUEMOUND RD
Second Line	:	SUITE 125A
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3367
Country	:	US
Telephone Number	:	414-302-3859
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/18/2021

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