Provider Demographics
NPI:1184647216
Name:JAKSA, NICOLA IOSIF (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:IOSIF
Last Name:JAKSA
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:BOX 41037
Mailing Address - Street 2:35040 HELZE LANE
Mailing Address - City:MEMPHIS
Mailing Address - State:MI
Mailing Address - Zip Code:48041
Mailing Address - Country:US
Mailing Address - Phone:810-392-7373
Mailing Address - Fax:810-392-8331
Practice Address - Street 1:35040 HELZE LANE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041
Practice Address - Country:US
Practice Address - Phone:810-392-7373
Practice Address - Fax:810-392-8331
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINJ008176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4370233Medicaid
MI950E01704OOtherBLUE CROSS
MI950E01704OOtherBLUE CROSS