Provider Demographics
NPI:1710014493
Name:HOUSTON, JACOB C (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:C
Last Name:HOUSTON
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 1:116 ROYAL OAKS BLVD
Mailing Address - Street 2:SUITE120
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1831
Mailing Address - Country:US
Mailing Address - Phone:615-591-0123
Mailing Address - Fax:
Practice Address - Street 1:116 ROYAL OAKS BLVD
Practice Address - Street 2:SUITE120
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1831
Practice Address - Country:US
Practice Address - Phone:615-591-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4067859OtherBCBS
TN11496691OtherCIGNA
TNU96213Medicare UPIN
TN3970212Medicare ID - Type UnspecifiedMEDICARE