Provider Demographics
NPI:1225623374
Name:JACOB, BRANDON TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:TAYLOR
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 1:111 ROUTE 70 E APT 5242
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2260
Mailing Address - Country:US
Mailing Address - Phone:609-781-4053
Mailing Address - Fax:
Practice Address - Street 1:3301 SCHOOLHOUSE LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4726
Practice Address - Country:US
Practice Address - Phone:717-652-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty