Provider Demographics
NPI:1528231925
Name:JACOBS, HENRY (DC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
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 1:455 EAST PACES ROAD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3030
Mailing Address - Country:US
Mailing Address - Phone:404-233-0208
Mailing Address - Fax:404-264-1470
Practice Address - Street 1:455 EAST PACES RD. NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3030
Practice Address - Country:US
Practice Address - Phone:404-233-0208
Practice Address - Fax:404-264-1470
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor