Provider Demographics
NPI:1447547872
Name:ETHEART, JACQUES DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:DANIEL
Last Name:ETHEART
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 1:600 S DIXIE HWY
Mailing Address - Street 2:APT 637
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5824
Mailing Address - Country:US
Mailing Address - Phone:314-825-1506
Mailing Address - Fax:
Practice Address - Street 1:3030 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1539
Practice Address - Country:US
Practice Address - Phone:561-650-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor