Provider Demographics
NPI:1982668943
Name:JACOBS, DAVID C (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 MISTY MORNING CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2065
Mailing Address - Country:US
Mailing Address - Phone:859-323-5533
Mailing Address - Fax:859-257-8696
Practice Address - Street 1:3605 MISTY MORNING CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2065
Practice Address - Country:US
Practice Address - Phone:859-323-5533
Practice Address - Fax:859-257-8696
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer