Provider Demographics
NPI:1851364525
Name:MURRAY, JACK L JR (DC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:L
Last Name:MURRAY
Suffix:JR
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 1:12 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2412
Mailing Address - Country:US
Mailing Address - Phone:301-722-4400
Mailing Address - Fax:301-722-5527
Practice Address - Street 1:12 DECATUR ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2412
Practice Address - Country:US
Practice Address - Phone:301-722-4400
Practice Address - Fax:301-722-5527
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW2170001OtherDC BLUE CROSS #
MD1016817OtherWV WORKERS COMP#
MDM533JLOtherBLUE CROSS PIN
MD258280OtherMAMSI #
MD629436OtherACN #
MD7998875OtherASHN #
MDM533JLOtherBLUE CROSS PIN
MDW2170001OtherDC BLUE CROSS #
MDU03142Medicare UPIN