Provider Demographics
NPI:1790833176
Name:EIVINS, JACK MILLER (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MILLER
Last Name:EIVINS
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 1:1506 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4914
Mailing Address - Country:US
Mailing Address - Phone:559-734-1110
Mailing Address - Fax:559-734-1123
Practice Address - Street 1:1506 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4914
Practice Address - Country:US
Practice Address - Phone:559-734-1110
Practice Address - Fax:559-734-1123
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA023798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor