Provider Demographics
NPI:1962477489
Name:NORSWORTHY, JACK EARL JR (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EARL
Last Name:NORSWORTHY
Suffix:JR
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 1:1305 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2121
Mailing Address - Country:US
Mailing Address - Phone:302-994-6575
Mailing Address - Fax:302-994-2374
Practice Address - Street 1:1305 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2121
Practice Address - Country:US
Practice Address - Phone:302-994-6575
Practice Address - Fax:302-994-2374
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01935OtherHIGHMARK MEDICARE
DEG01935OtherHIGHMARK MEDICARE