Jack, David

Jack, David is an individual health care provider with primary practice located at 1620 E Bulldog Ln , Fresno CA 93740-0001. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Jack, David can be contacted via phone (559) 278-4170.

Contact Information

Primary practice address
1620 E Bulldog Ln Fresno CA 93740-0001
Phone: (559) 278-4170
Fax: (559) 278-8355
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X

Profile Details

NPI number 1235416686
LBN Legal business name Jack, David
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2011
Last updated Nov 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235416686 NPPES
California Other 22 RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS

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