Provider Demographics
NPI:1326075466
Name:SELLS, JACK DAVIS (DC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:DAVIS
Last Name:SELLS
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 1:3703 TAYLORSVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1330
Mailing Address - Country:US
Mailing Address - Phone:502-558-0099
Mailing Address - Fax:502-709-5414
Practice Address - Street 1:3703 TAYLORSVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1330
Practice Address - Country:US
Practice Address - Phone:502-558-0099
Practice Address - Fax:502-709-5414
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000191553OtherANTHEM