Provider Demographics
NPI:1821480948
Name:WERNER, JACOB ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ROBERT
Last Name:WERNER
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 1:601 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-9659
Mailing Address - Country:US
Mailing Address - Phone:715-255-3594
Mailing Address - Fax:
Practice Address - Street 1:601 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9659
Practice Address - Country:US
Practice Address - Phone:715-255-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6010111N00000X
WI5130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor