Provider Demographics
NPI:1396214136
Name:JACQUES, DAVID DANIEL
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DANIEL
Last Name:JACQUES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CHESTERFIELD LN APT 2
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3886
Mailing Address - Country:US
Mailing Address - Phone:513-388-7222
Mailing Address - Fax:
Practice Address - Street 1:700 LEMOYNE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1867
Practice Address - Country:US
Practice Address - Phone:513-388-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer