Provider Demographics
NPI:1700963618
Name:WACK, JEFFREY GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:WACK
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 1:206 E LAWN RD
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1114
Mailing Address - Country:US
Mailing Address - Phone:610-746-4949
Mailing Address - Fax:
Practice Address - Street 1:206 E LAWN RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-1114
Practice Address - Country:US
Practice Address - Phone:610-746-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003316L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor