Provider Demographics
NPI:1396821039
Name:JACOBS, SHARI R (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:R
Last Name:JACOBS
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 1:485 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4706
Mailing Address - Country:US
Mailing Address - Phone:516-538-8361
Mailing Address - Fax:516-565-1248
Practice Address - Street 1:485 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4706
Practice Address - Country:US
Practice Address - Phone:516-538-8361
Practice Address - Fax:516-565-1248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO4717-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX27881Medicare ID - Type Unspecified