Provider Demographics
NPI:1114051141
Name:JACOBS, JASON RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RONALD
Last Name:JACOBS
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-0143
Mailing Address - Country:US
Mailing Address - Phone:724-478-1501
Mailing Address - Fax:724-478-1552
Practice Address - Street 1:65 DOLBY ST STE 2
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8517
Practice Address - Country:US
Practice Address - Phone:724-478-1501
Practice Address - Fax:724-478-1552
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007865-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJA607918OtherHIGHMARK BS
PA045924P0DMedicare ID - Type Unspecified