Provider Demographics
NPI:1639614449
Name:JACOBS, DAVID M (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
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 1:519 W CARSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2617
Mailing Address - Country:US
Mailing Address - Phone:310-533-1070
Mailing Address - Fax:
Practice Address - Street 1:519 W CARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2617
Practice Address - Country:US
Practice Address - Phone:310-533-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor