Provider Demographics
NPI:1700053014
Name:BEN JAKOB, D.C., P.C.
Entity Type:Organization
Organization Name:BEN JAKOB, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-580-1616
Mailing Address - Street 1:4000 OLD COURT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6415
Mailing Address - Country:US
Mailing Address - Phone:410-580-1616
Mailing Address - Fax:410-580-1153
Practice Address - Street 1:4000 OLD COURT RD STE 206
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6415
Practice Address - Country:US
Practice Address - Phone:410-580-1616
Practice Address - Fax:410-580-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty