Provider Demographics
NPI:1326375072
Name:ARCHIE, JACOB ALAN (DC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ALAN
Last Name:ARCHIE
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 1:64 SPRINGSIDE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9780
Mailing Address - Country:US
Mailing Address - Phone:731-784-3444
Mailing Address - Fax:731-784-8868
Practice Address - Street 1:400 US HIGHWAY 45 W
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-8503
Practice Address - Country:US
Practice Address - Phone:731-784-3444
Practice Address - Fax:731-784-8868
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor