Provider Demographics
NPI:1790831873
Name:JACOBS, CARLA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:SUE
Last Name:JACOBS
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 1:528 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0633961Medicaid
OHJA-0588361Medicare ID - Type Unspecified