Individual
DR. HARVEY P JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1570 36 AVE SUITE 4, MOLINE, IL 61265
(309) 762-5225
(309) 764-7679
Mailing address
1570 36 AVE SUITE 4, MOLINE, IL 61265
(309) 762-5225
(309) 764-7679
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08132078
BLUE CROSS&BLUE SHEILD
IL
Enumeration date
10/05/2006
Last updated
07/08/2007
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