Provider Demographics
NPI:1245369917
Name:JACOBS, DOROTHEY ERIN (D C)
Entity type:Individual
Prefix:DR
First Name:DOROTHEY
Middle Name:ERIN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10405
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-0405
Mailing Address - Country:US
Mailing Address - Phone:662-374-5252
Mailing Address - Fax:
Practice Address - Street 1:805 W PARK AVE STE 5A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2832
Practice Address - Country:US
Practice Address - Phone:662-374-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2170111N00000X
MS1103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07922069Medicaid
MS07922069Medicaid
MS3023I57877Medicare PIN