Provider Demographics
NPI:1447060736
Name:FACINELLI, JACKSON BRADY (DC)
Entity type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:BRADY
Last Name:FACINELLI
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ELK ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5247
Mailing Address - Country:US
Mailing Address - Phone:307-362-5352
Mailing Address - Fax:
Practice Address - Street 1:706 ELK ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5247
Practice Address - Country:US
Practice Address - Phone:307-362-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor