Provider Demographics
NPI:1407999055
Name:JACOBS, IRVING LIONEL (DC)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:LIONEL
Last Name:JACOBS
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 1:14843 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3339
Mailing Address - Country:US
Mailing Address - Phone:818-782-5777
Mailing Address - Fax:818-782-9233
Practice Address - Street 1:14843 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3339
Practice Address - Country:US
Practice Address - Phone:818-782-5777
Practice Address - Fax:818-782-9233
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17133Medicare ID - Type Unspecified