Chan, J. Jack

Chan, J. Jack is an individual health care provider with primary practice located at 86 Columbus Rd Ste 203, Athens OH 45701-1331. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Chan, J. Jack can be contacted via phone (740) 594-2624.

Contact Information

Primary practice address
86 Columbus Rd Ste 203 Athens OH 45701-1331
Phone: (740) 594-2624
Fax: (740) 594-7333
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 34005890 Ohio

Profile Details

NPI number 1053314245
LBN Legal business name Chan, J. Jack
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2005
Last updated May 19th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053314245 NPPES
Ohio MEDICAID 0956881

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