Provider Demographics
NPI:1922134162
Name:JACOBS, CARROLL STOCKTON (ND)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:STOCKTON
Last Name:JACOBS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4414
Mailing Address - Country:US
Mailing Address - Phone:540-256-1045
Mailing Address - Fax:540-213-1350
Practice Address - Street 1:219 W BEVERLEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4287
Practice Address - Country:US
Practice Address - Phone:540-213-1350
Practice Address - Fax:540-213-1350
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1502175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath