Provider Demographics
NPI:1740009893
Name:JACK EIVINS CHIROPRACTIC
Entity type:Organization
Organization Name:JACK EIVINS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:EIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-734-1110
Mailing Address - Street 1:1506 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4914
Mailing Address - Country:US
Mailing Address - Phone:559-734-1110
Mailing Address - Fax:559-734-1123
Practice Address - Street 1:1506 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4914
Practice Address - Country:US
Practice Address - Phone:559-734-1110
Practice Address - Fax:559-734-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service