Provider Demographics
NPI:1912021205
Name:JACOBSON, BRUCE M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:JACOBSON
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 1:1547 STUYVESANT AVE # A
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5341
Mailing Address - Country:US
Mailing Address - Phone:908-687-5544
Mailing Address - Fax:908-687-5543
Practice Address - Street 1:1547 STUYVESANT AVE # A
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5341
Practice Address - Country:US
Practice Address - Phone:908-687-5544
Practice Address - Fax:908-687-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC5675111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology