Provider Demographics
NPI:1215183314
Name:JACOBSOHN, WENDY (DC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:JACOBSOHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 18TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1951
Mailing Address - Country:US
Mailing Address - Phone:310-828-7004
Mailing Address - Fax:
Practice Address - Street 1:817 18TH ST APT 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1951
Practice Address - Country:US
Practice Address - Phone:310-828-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21377OtherSTATE LICENSE NUMBER