Provider Demographics
NPI:1922656107
Name:ALECK, JACOB (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ALECK
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 1:11 S WHITE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-4011
Mailing Address - Country:US
Mailing Address - Phone:815-405-5269
Mailing Address - Fax:
Practice Address - Street 1:11 S WHITE ST STE 201
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-4011
Practice Address - Country:US
Practice Address - Phone:815-405-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013559111N00000X
SC4476111N00000X
IL038.013559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor