Individual
MR. DAVID JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1620 E BULLDOG LN, FRESNO, CA 93740-0001
(559) 278-4170
(559) 278-8355
Mailing address
1620 E BULLDOG LN, FRESNO, CA 93740-0001
(559) 278-4170
(559) 278-8355
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
CA
Enumeration date
11/14/2011
Last updated
11/14/2011
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