Provider Demographics
NPI:1922316868
Name:THE VALIANT JACOBS CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:THE VALIANT JACOBS CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITCH
Authorized Official - Middle Name:VALIANT
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-218-8648
Mailing Address - Street 1:2901 K STREET. SUITE 120C
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-448-1770
Mailing Address - Fax:916-448-3015
Practice Address - Street 1:3 POPPY LN
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-1533
Practice Address - Country:US
Practice Address - Phone:650-218-8648
Practice Address - Fax:650-594-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty