Provider Demographics
NPI:1326225756
Name:JACKSON CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:JACKSON CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-286-4890
Mailing Address - Street 1:63 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1638
Mailing Address - Country:US
Mailing Address - Phone:740-286-4890
Mailing Address - Fax:740-286-6115
Practice Address - Street 1:63 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1638
Practice Address - Country:US
Practice Address - Phone:740-286-4890
Practice Address - Fax:740-286-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9269911Medicaid
OH9269911Medicaid
OHKI0609692Medicare PIN