Provider Demographics
NPI:1578591905
Name:BRITTAIN, JACOB MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:BRITTAIN
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 1:3021 EAGLECREST DR
Mailing Address - Street 2:B1
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6193
Mailing Address - Country:US
Mailing Address - Phone:913-638-2501
Mailing Address - Fax:
Practice Address - Street 1:3021 EAGLECREST DR
Practice Address - Street 2:B1
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6193
Practice Address - Country:US
Practice Address - Phone:913-638-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS36050013OtherBCBS #
KST40E199OtherMEDICARE INDIVIDUAL #
KST40E199OtherMEDICARE INDIVIDUAL #