Provider Demographics
NPI:1003115320
Name:JACOBS, DANUBE S (LAC)
Entity Type:Individual
Prefix:
First Name:DANUBE
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 E HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2424
Mailing Address - Country:US
Mailing Address - Phone:520-548-1894
Mailing Address - Fax:
Practice Address - Street 1:2843 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2812
Practice Address - Country:US
Practice Address - Phone:520-548-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR154036171100000X
AZ0903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist