Provider Demographics
NPI:1184666141
Name:ROWE, JACQUES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:L
Last Name:ROWE
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 1:13838 QUAIL POINTE DR
Mailing Address - Street 2:STE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1001
Mailing Address - Country:US
Mailing Address - Phone:405-478-8220
Mailing Address - Fax:405-748-4209
Practice Address - Street 1:13838 QUAIL POINTE DR
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1001
Practice Address - Country:US
Practice Address - Phone:405-478-8220
Practice Address - Fax:405-748-4209
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT80009Medicare UPIN