Provider Demographics
NPI:1144254962
Name:HALSEY, JACK EUGENE JR (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EUGENE
Last Name:HALSEY
Suffix:JR
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 1:2140 S MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-2632
Mailing Address - Country:US
Mailing Address - Phone:918-664-5180
Mailing Address - Fax:918-664-5188
Practice Address - Street 1:2140 S MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-2632
Practice Address - Country:US
Practice Address - Phone:918-664-5180
Practice Address - Fax:918-664-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDCBWMedicare ID - Type UnspecifiedMEDICARE NUMBER