Provider Demographics
NPI:1407140833
Name:JACOBS, ALISHA (DC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
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:PO BOX 270474
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-0474
Mailing Address - Country:US
Mailing Address - Phone:970-420-9489
Mailing Address - Fax:
Practice Address - Street 1:1103 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6273
Practice Address - Country:US
Practice Address - Phone:970-420-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6759111N00000X
OR4117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor