Provider Demographics
NPI:1710003199
Name:CHAD S. JACOBS, D.C., INC.
Entity Type:Organization
Organization Name:CHAD S. JACOBS, D.C., INC.
Other - Org Name:WESTERVILLE FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-898-9195
Mailing Address - Street 1:528 S OTTERBEIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2913
Mailing Address - Country:US
Mailing Address - Phone:614-898-9195
Mailing Address - Fax:614-898-9188
Practice Address - Street 1:528 S OTTERBEIN AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2913
Practice Address - Country:US
Practice Address - Phone:614-898-9195
Practice Address - Fax:614-898-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH299621907-00OtherWORKERS' COMPENSATION
OH0869832Medicaid
OH1073669164OtherINDIVIDUAL NPI NUMBER
OH1073669164OtherINDIVIDUAL NPI NUMBER