Provider Demographics
NPI:1245617778
Name:JACOBSON, KERRI MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:MICHELLE
Last Name:JACOBSON
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 1:1017 WASHINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3633
Mailing Address - Country:US
Mailing Address - Phone:570-567-7765
Mailing Address - Fax:570-567-7803
Practice Address - Street 1:911 WESTMINSTER DR STE 7
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3900
Practice Address - Country:US
Practice Address - Phone:570-447-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor