Provider Demographics
NPI:1235884453
Name:CRACKYOURBACKJACK, INC.
Entity Type:Organization
Organization Name:CRACKYOURBACKJACK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-631-8313
Mailing Address - Street 1:4539 OLYMPUS LOOP
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8069
Mailing Address - Country:US
Mailing Address - Phone:360-631-8313
Mailing Address - Fax:
Practice Address - Street 1:7901 SKANSIE AVE STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8349
Practice Address - Country:US
Practice Address - Phone:253-358-6094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty