Provider Demographics
NPI:1437373289
Name:MACKLER, JACK R (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:R
Last Name:MACKLER
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 1:4 ARLIVE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1712 I ST NW
Practice Address - Street 2:SUITE 1012
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-857-0003
Practice Address - Fax:202-857-5380
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC14833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor