Provider Demographics
NPI:1699041459
Name:DR BRIAN JACOBY LLC
Entity Type:Organization
Organization Name:DR BRIAN JACOBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1847-338-7590
Mailing Address - Street 1:1735 N PAULINA ST
Mailing Address - Street 2:# 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1133
Mailing Address - Country:US
Mailing Address - Phone:184-733-8759
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:1360 N SANDBURG TERRACE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2050
Practice Address - Country:US
Practice Address - Phone:312-944-4653
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011130OtherPHYSICIAN LICENSE