Provider Demographics
NPI:1518175108
Name:MCINERNY, JACK W (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:W
Last Name:MCINERNY
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 1:4701 AUBURN WAY N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1312
Mailing Address - Country:US
Mailing Address - Phone:253-850-2225
Mailing Address - Fax:253-850-5757
Practice Address - Street 1:4701 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1312
Practice Address - Country:US
Practice Address - Phone:253-850-2225
Practice Address - Fax:253-850-5757
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0002412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8377947Medicaid
WA55469OtherDEPT OF L&I
WA55469OtherDEPT OF L&I