Provider Demographics
NPI:1083859359
Name:JACOB, DAVID JIM (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JIM
Last Name:JACOB
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 1:17220 FREMONT LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1786
Mailing Address - Country:US
Mailing Address - Phone:714-222-3874
Mailing Address - Fax:714-528-9865
Practice Address - Street 1:312 W CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6550
Practice Address - Country:US
Practice Address - Phone:714-991-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor