Provider Demographics
NPI:1710982087
Name:JACOBS HENEY, THERESE (DC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:JACOBS HENEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROCKLAND ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2385
Mailing Address - Country:US
Mailing Address - Phone:781-826-7397
Mailing Address - Fax:781-826-7469
Practice Address - Street 1:24 ROCKLAND ST
Practice Address - Street 2:UNIT 1
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2385
Practice Address - Country:US
Practice Address - Phone:781-826-7397
Practice Address - Fax:781-826-7469
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35605Medicare PIN