Provider Demographics
NPI:1518018712
Name:FALCONER, JASPER BROCK (DC)
Entity Type:Individual
Prefix:
First Name:JASPER
Middle Name:BROCK
Last Name:FALCONER
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 1:18 N BOEKE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-6014
Mailing Address - Country:US
Mailing Address - Phone:812-477-6200
Mailing Address - Fax:812-477-6203
Practice Address - Street 1:18 N BOEKE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-6014
Practice Address - Country:US
Practice Address - Phone:812-477-6200
Practice Address - Fax:812-477-6203
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002389A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025673Medicare ID - Type Unspecified