Provider Demographics
NPI:1598848566
Name:SIEKERKA, JACK R (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:R
Last Name:SIEKERKA
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 1:983 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6611
Mailing Address - Country:US
Mailing Address - Phone:619-447-3779
Mailing Address - Fax:619-447-3899
Practice Address - Street 1:983 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6611
Practice Address - Country:US
Practice Address - Phone:619-447-3779
Practice Address - Fax:619-447-3899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6353324Medicare ID - Type Unspecified
CAU19861Medicare UPIN