Provider Demographics
NPI:1932661014
Name:HOWARD, JACK (DC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:HOWARD
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 1:13223 VENTURA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1801
Mailing Address - Country:US
Mailing Address - Phone:818-981-2639
Mailing Address - Fax:818-981-2640
Practice Address - Street 1:13223 VENTURA BLVD STE D
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1801
Practice Address - Country:US
Practice Address - Phone:818-981-2639
Practice Address - Fax:818-981-2640
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor