Provider Demographics
NPI:1780887141
Name:CRACKNELL, JESSE (DC,)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:CRACKNELL
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 1:3427 WAIALAE AVE # 335
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2619
Mailing Address - Country:US
Mailing Address - Phone:808-737-4325
Mailing Address - Fax:808-737-4324
Practice Address - Street 1:3615 HARDING AVE STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3760
Practice Address - Country:US
Practice Address - Phone:808-737-4325
Practice Address - Fax:808-737-4324
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55683Medicare ID - Type Unspecified