Provider Demographics
NPI:1245684786
Name:JACOBS, JUDY ANN (DC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:JACOBS
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 1:3061 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4241
Mailing Address - Country:US
Mailing Address - Phone:305-541-5581
Mailing Address - Fax:305-541-3713
Practice Address - Street 1:3061 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4241
Practice Address - Country:US
Practice Address - Phone:305-541-5581
Practice Address - Fax:305-541-3713
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6333111N00000X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health