Provider Demographics
NPI:1144304981
Name:JACKEL, DAVID LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:JACKEL
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 1:2940 JAMACHA RD STE L
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4493
Mailing Address - Country:US
Mailing Address - Phone:619-660-0707
Mailing Address - Fax:619-660-1605
Practice Address - Street 1:2940 JAMACHA RD STE L
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4493
Practice Address - Country:US
Practice Address - Phone:619-660-0707
Practice Address - Fax:619-660-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26412111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA677108Medicare UPIN