David Daniel Jacques
Individual provider Active NPI Athletic Trainer · Northwood, OH
NPI 1396214136 · NPPES record last updated Sep 17, 2021
Key facts
- NPI
- 1396214136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 700 Lemoyne Rd
Northwood, OH 43619-1867 - Phone
- (513) 388-7222
- NPI assigned
- Nov 23, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedarville University EMS | Past | Accepting new patients | |
| Cedarville University | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
700 Lemoyne Rd
Northwood, OH 43619-1867
Mailing address
156 Chesterfield LN Apt 2
Maumee, OH 43537-3886
Phone (513) 388-7222
Other providers in Northwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.