Provider Demographics
NPI:1134550080
Name:JACOBSON, JENNA (DC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1228
Mailing Address - Country:US
Mailing Address - Phone:936-522-7811
Mailing Address - Fax:
Practice Address - Street 1:1636 FRUITLAND DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-1208
Practice Address - Country:US
Practice Address - Phone:936-522-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007055111N00000X
WACH 60438775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor