Provider Demographics
NPI:1265169619
Name:JACOBI, SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:JACOBI
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 1:1646 W CHESTER PIKE STE 20
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7979
Mailing Address - Country:US
Mailing Address - Phone:484-999-8142
Mailing Address - Fax:484-999-8365
Practice Address - Street 1:1646 W CHESTER PIKE STE 20
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7979
Practice Address - Country:US
Practice Address - Phone:484-999-8142
Practice Address - Fax:484-999-8365
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor