Provider Demographics
NPI:1063630325
Name:JACOBSEN, MICHAEL ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:JACOBSEN
Suffix:
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 1:8001 N DALE MABRY HWY
Mailing Address - Street 2:BLGD 301
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3264
Mailing Address - Country:US
Mailing Address - Phone:813-933-1511
Mailing Address - Fax:813-931-8393
Practice Address - Street 1:8001 N DALE MABRY HWY STE 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3264
Practice Address - Country:US
Practice Address - Phone:813-933-1511
Practice Address - Fax:813-931-8393
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85328Medicare UPIN