Provider Demographics
NPI:1336610831
Name:JACOBS, BRETT CODY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CODY
Last Name:JACOBS
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 1:7428 GUERNSEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KIMBOLTON
Mailing Address - State:OH
Mailing Address - Zip Code:43749-9525
Mailing Address - Country:US
Mailing Address - Phone:330-340-1342
Mailing Address - Fax:
Practice Address - Street 1:109 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1213
Practice Address - Country:US
Practice Address - Phone:330-340-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor