Provider Demographics
NPI:1760138580
Name:PRIDDLE, JACOB W (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:PRIDDLE
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 1:830 POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6055
Mailing Address - Country:US
Mailing Address - Phone:785-537-9330
Mailing Address - Fax:785-776-2437
Practice Address - Street 1:830 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6055
Practice Address - Country:US
Practice Address - Phone:785-537-9330
Practice Address - Fax:785-776-2437
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor