Provider Demographics
NPI:1063522092
Name:HIGHLEY, JACKSON HERSCHEL (MA, DC)
Entity type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:HERSCHEL
Last Name:HIGHLEY
Suffix:
Gender:
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KING ST STE D
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6264
Mailing Address - Country:US
Mailing Address - Phone:360-676-4488
Mailing Address - Fax:360-647-5587
Practice Address - Street 1:1420 KING ST STE D
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6264
Practice Address - Country:US
Practice Address - Phone:360-676-4488
Practice Address - Fax:360-647-5587
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00038364OtherRR MEDICARE
WA0035429OtherLABOR & INDUSTRIES
WA314005001OtherGROUP HEALTH
WAU230808Medicare UPIN