Provider Demographics
NPI:1497837728
Name:JAKOB, BEN (DC,PC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:JAKOB
Suffix:
Gender:M
Credentials:DC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD COURT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6415
Mailing Address - Country:US
Mailing Address - Phone:410-580-1616
Mailing Address - Fax:410-580-1153
Practice Address - Street 1:4000 OLD COURT RD STE 206
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6415
Practice Address - Country:US
Practice Address - Phone:410-580-1616
Practice Address - Fax:410-580-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409827700Medicaid
MD64763601OtherMD CAREFIRST RENDERING #
DCK951OtherCAREFIRST PROVIDER #
MD354 CBOtherCAREFIRST MD PROVIDER #
MD64763601OtherMD CAREFIRST RENDERING #
MD354 CBOtherCAREFIRST MD PROVIDER #