Provider Demographics
NPI:1639760614
Name:HYDE, JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HYDE
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 1:5719 N KAYLA CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8365
Mailing Address - Country:US
Mailing Address - Phone:480-707-2023
Mailing Address - Fax:
Practice Address - Street 1:2362 N OLD MILL LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4954
Practice Address - Country:US
Practice Address - Phone:208-209-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor