Provider Demographics
NPI:1740425404
Name:JACOBS, SHAWN (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 E. MAIN ST
Mailing Address - Street 2:SUITE 3 SHAWN JACOBS
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302
Mailing Address - Country:US
Mailing Address - Phone:864-948-9950
Mailing Address - Fax:
Practice Address - Street 1:753 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1284
Practice Address - Country:US
Practice Address - Phone:864-948-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist