Provider Demographics
NPI:1871693770
Name:D.R. THOMAS V. JACQUES D.C., PSC
Entity type:Organization
Organization Name:D.R. THOMAS V. JACQUES D.C., PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-456-5353
Mailing Address - Street 1:3318 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4602
Mailing Address - Country:US
Mailing Address - Phone:502-456-5353
Mailing Address - Fax:502-456-5373
Practice Address - Street 1:3318 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4602
Practice Address - Country:US
Practice Address - Phone:502-456-5353
Practice Address - Fax:502-456-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7191Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER