Provider Demographics
NPI:1659446797
Name:JACOBS, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
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 1:18411 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5042
Mailing Address - Country:US
Mailing Address - Phone:310-516-8900
Mailing Address - Fax:310-516-8989
Practice Address - Street 1:18411 CRENSHAW BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5042
Practice Address - Country:US
Practice Address - Phone:310-516-8900
Practice Address - Fax:310-516-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor