Provider Demographics
NPI:1588977573
Name:HAVEL, JACQUELINE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARIE
Last Name:HAVEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1642
Mailing Address - Country:US
Mailing Address - Phone:651-699-5619
Mailing Address - Fax:651-699-5639
Practice Address - Street 1:1821 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1642
Practice Address - Country:US
Practice Address - Phone:651-699-5619
Practice Address - Fax:651-699-5639
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8158111N00000X
MN5455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor