Provider Demographics
NPI:1578559795
Name:JACOBSON, WILLIAM WARNER II (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WARNER
Last Name:JACOBSON
Suffix:II
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 1:446 N CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2460
Mailing Address - Country:US
Mailing Address - Phone:626-793-1633
Mailing Address - Fax:
Practice Address - Street 1:446 N CRAIG AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2460
Practice Address - Country:US
Practice Address - Phone:626-793-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82652Medicare UPIN
CADC17560Medicare ID - Type Unspecified