Provider Demographics
NPI:1245886647
Name:LAWFER, JACLYN (DC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:LAWFER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 N ALLEN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1816
Mailing Address - Country:US
Mailing Address - Phone:815-266-9619
Mailing Address - Fax:309-316-1220
Practice Address - Street 1:8305 N ALLEN RD STE 7
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1816
Practice Address - Country:US
Practice Address - Phone:309-621-1410
Practice Address - Fax:309-316-1220
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor