Provider Demographics
NPI:1780804633
Name:JETT CHIROPRACTIC HEALTH CARE, P.C.
Entity type:Organization
Organization Name:JETT CHIROPRACTIC HEALTH CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-997-0444
Mailing Address - Street 1:7150 AUSTIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4731
Mailing Address - Country:US
Mailing Address - Phone:718-997-0444
Mailing Address - Fax:718-997-0443
Practice Address - Street 1:7306 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6251
Practice Address - Country:US
Practice Address - Phone:718-997-0444
Practice Address - Fax:718-997-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06800GMedicare ID - Type Unspecified