Provider Demographics
NPI:1245389378
Name:JACOBS, DEAN A (CHIROPRACTOR)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6702
Mailing Address - Country:US
Mailing Address - Phone:319-337-3856
Mailing Address - Fax:
Practice Address - Street 1:2 AMBER LN
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6702
Practice Address - Country:US
Practice Address - Phone:319-337-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
421323693OtherFEDERAL TAX ID
IA1257147Medicaid
IA1257147Medicaid