Provider Demographics
NPI:1407689284
Name:MACIEJCZAK, JARED DANIEL (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DANIEL
Last Name:MACIEJCZAK
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 1:14209 POTTER PKWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-2117
Mailing Address - Country:US
Mailing Address - Phone:605-391-0051
Mailing Address - Fax:
Practice Address - Street 1:15615 PACIFIC ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2187
Practice Address - Country:US
Practice Address - Phone:402-933-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor