Provider Demographics
NPI:1578844874
Name:HEALEY, JACOB HAMBLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:HAMBLIN
Last Name:HEALEY
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 1:13291 W MCDOWELL RD STE E4
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2634
Mailing Address - Country:US
Mailing Address - Phone:623-218-6676
Mailing Address - Fax:
Practice Address - Street 1:13291 W MCDOWELL RD STE E4
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2634
Practice Address - Country:US
Practice Address - Phone:623-218-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102536Medicare PIN