Provider Demographics
NPI:1891780177
Name:GIACOBBE, SANDY (DC)
Entity Type:Individual
Prefix:MR
First Name:SANDY
Middle Name:
Last Name:GIACOBBE
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 1:18 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9561
Mailing Address - Country:US
Mailing Address - Phone:908-362-8767
Mailing Address - Fax:908-362-8770
Practice Address - Street 1:18 STILLWATER RD
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-9561
Practice Address - Country:US
Practice Address - Phone:908-362-8767
Practice Address - Fax:908-362-8770
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00455900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGI695627Medicare ID - Type Unspecified
T53093Medicare UPIN