Provider Demographics
NPI:1245871268
Name:NYBO, JACE L (DC)
Entity type:Individual
Prefix:
First Name:JACE
Middle Name:L
Last Name:NYBO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-316-9272
Practice Address - Street 1:2919 S ELLSWORTH RD STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2165
Practice Address - Country:US
Practice Address - Phone:480-564-1185
Practice Address - Fax:480-590-4375
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN6654111N00000X
AZ8944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor