Provider Demographics
NPI:1093837684
Name:ISBELL, JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:ISBELL
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 1:26357 PEACOCK PL
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1143
Mailing Address - Country:US
Mailing Address - Phone:818-618-6207
Mailing Address - Fax:
Practice Address - Street 1:14901 RINALDI ST STE 335
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1237
Practice Address - Country:US
Practice Address - Phone:818-365-9690
Practice Address - Fax:818-365-9199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12713111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology