Provider Demographics
NPI:1568599959
Name:JACOBS, RANDY JAY (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:JAY
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 1:28529 MOUNTAINVIEW RD SUITE C
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433
Mailing Address - Country:US
Mailing Address - Phone:303-838-7700
Mailing Address - Fax:
Practice Address - Street 1:28529 MOUNTAIN VIEW RD UNIT C
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7262
Practice Address - Country:US
Practice Address - Phone:303-838-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3501111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44943Medicare ID - Type UnspecifiedMEDICARE NUMBER