Provider Demographics
NPI:1508918103
Name:JACOBS CHIROPRACTIC ACUPUNCTURE, P.A.
Entity Type:Organization
Organization Name:JACOBS CHIROPRACTIC ACUPUNCTURE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-774-6251
Mailing Address - Street 1:138 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3021
Mailing Address - Country:US
Mailing Address - Phone:207-774-6251
Mailing Address - Fax:207-774-6252
Practice Address - Street 1:138 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3021
Practice Address - Country:US
Practice Address - Phone:207-774-6251
Practice Address - Fax:207-774-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty