Provider Demographics
NPI:1003154378
Name:JACOB M FUNK, LLC
Entity Type:Organization
Organization Name:JACOB M FUNK, LLC
Other - Org Name:BETTER HEALTH & PERFORMANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-659-2080
Mailing Address - Street 1:1409 TROY RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2532
Mailing Address - Country:US
Mailing Address - Phone:618-659-2080
Mailing Address - Fax:
Practice Address - Street 1:1409 TROY RD
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2532
Practice Address - Country:US
Practice Address - Phone:618-659-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty