Provider Demographics
NPI:1073172938
Name:JACOBS, TAYLOR LADELL
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LADELL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BIDDY RD SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4035
Mailing Address - Country:US
Mailing Address - Phone:706-346-3363
Mailing Address - Fax:
Practice Address - Street 1:1012 S WALL ST STE A
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3066
Practice Address - Country:US
Practice Address - Phone:706-624-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor