Provider Demographics
NPI:1043325871
Name:DECKER, JAY E (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:E
Last Name:DECKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-3810
Mailing Address - Country:US
Mailing Address - Phone:928-289-3451
Mailing Address - Fax:
Practice Address - Street 1:415 N APACHE AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-3810
Practice Address - Country:US
Practice Address - Phone:928-289-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ350028483OtherRAILROAD MEDICARE NUMBER
AZDC5149Medicare ID - Type UnspecifiedMEDICARE-B NUMBER
AZ350028483OtherRAILROAD MEDICARE NUMBER