Provider Demographics
NPI:1902210883
Name:JACOBS, KIMBERLY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 COMMON ST., SUITE 203
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3586
Mailing Address - Country:US
Mailing Address - Phone:830-608-1403
Mailing Address - Fax:830-608-1400
Practice Address - Street 1:1308 COMMON ST STE 203
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3561
Practice Address - Country:US
Practice Address - Phone:830-608-1403
Practice Address - Fax:830-608-1400
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist