Provider Demographics
NPI:1073904132
Name:NAVARRO, JACOB T (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:T
Last Name:NAVARRO
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 1:3018 OLD MINDEN RD STE 1203
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2446
Mailing Address - Country:US
Mailing Address - Phone:318-747-5855
Mailing Address - Fax:318-746-0417
Practice Address - Street 1:6535 FM 2920 RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2613
Practice Address - Country:US
Practice Address - Phone:281-376-1288
Practice Address - Fax:813-784-7062
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor