Provider Demographics
NPI:1972760007
Name:ATCHLEY, JAKE OLIVER (DC)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:OLIVER
Last Name:ATCHLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:RENE
Other - Last Name:ATCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1470 WANAAO RD
Mailing Address - Street 2:DR. JAKE ATCHLEY
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2628
Mailing Address - Country:US
Mailing Address - Phone:808-652-1962
Mailing Address - Fax:
Practice Address - Street 1:4-1104 KUHIO HWY
Practice Address - Street 2:#183
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1628
Practice Address - Country:US
Practice Address - Phone:808-652-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor