Provider Demographics
NPI:1801033345
Name:JACOBI, TAD LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:LOUIS
Last Name:JACOBI
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 1:732 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1753
Mailing Address - Country:US
Mailing Address - Phone:319-444-2555
Mailing Address - Fax:
Practice Address - Street 1:732 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1753
Practice Address - Country:US
Practice Address - Phone:319-444-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1444OtherMEDICARE PTAN