Provider Demographics
NPI:1134721152
Name:GRASSMYER, JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:GRASSMYER
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 1:309 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-9642
Mailing Address - Country:US
Mailing Address - Phone:419-551-7333
Mailing Address - Fax:
Practice Address - Street 1:102 W BRYAN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1202
Practice Address - Country:US
Practice Address - Phone:419-551-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011570111N00000X
OHDC-05353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor