Provider Demographics
NPI:1558874784
Name:LANGSTON, JACOB KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:KYLE
Last Name:LANGSTON
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40011-0293
Mailing Address - Country:US
Mailing Address - Phone:502-532-0099
Mailing Address - Fax:502-532-0096
Practice Address - Street 1:8172 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:KY
Practice Address - Zip Code:40011-1467
Practice Address - Country:US
Practice Address - Phone:502-532-0099
Practice Address - Fax:502-532-0096
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor