Provider Demographics
NPI:1356868061
Name:JACOBSON, DANIELLE (DC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
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 1:107 TAIL FEATHER LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3012
Mailing Address - Country:US
Mailing Address - Phone:786-250-7608
Mailing Address - Fax:
Practice Address - Street 1:2622 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3967
Practice Address - Country:US
Practice Address - Phone:406-585-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor