Provider Demographics
NPI:1780680587
Name:STARKEY, JACK BRUCE JR (D C)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:BRUCE
Last Name:STARKEY
Suffix:JR
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3245
Mailing Address - Country:US
Mailing Address - Phone:419-289-0330
Mailing Address - Fax:419-281-5448
Practice Address - Street 1:312 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3245
Practice Address - Country:US
Practice Address - Phone:419-289-0330
Practice Address - Fax:419-281-5448
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5001377OtherAETNA
OH000000345418OtherANTHEM
OH0802448Medicaid
OH20162371700OtherBWC GROUP NUMBER
OH4400947OtherUNITED HEALTHCARE
OHU53474Medicare UPIN
OH20162371700OtherBWC GROUP NUMBER
OH0802448Medicaid