Provider Demographics
NPI:1629225958
Name:JACOB, STEVEN (DOM, L AC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JACOB
Suffix:
Gender:M
Credentials:DOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 BOSTON POST RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1360
Mailing Address - Country:US
Mailing Address - Phone:203-453-2611
Mailing Address - Fax:
Practice Address - Street 1:2489 BOSTON POST RD
Practice Address - Street 2:SUITE F
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1360
Practice Address - Country:US
Practice Address - Phone:203-453-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist