Provider Demographics
NPI:1780824003
Name:NEWHOUSE, JACQUELINE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6381
Mailing Address - Country:US
Mailing Address - Phone:309-764-3613
Mailing Address - Fax:309-764-3965
Practice Address - Street 1:1909 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6381
Practice Address - Country:US
Practice Address - Phone:309-764-3613
Practice Address - Fax:309-764-3965
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor