Provider Demographics
NPI:1508084385
Name:JACOBSON, JAY P (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:JACOBSON
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 1:1219 LIBERTY AVE
Mailing Address - Street 2:HILLSIDE CHIROPRACTIC
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2055
Mailing Address - Country:US
Mailing Address - Phone:908-289-6667
Mailing Address - Fax:
Practice Address - Street 1:1219 LIBERTY AVE
Practice Address - Street 2:HILLSIDE CHIROPRACTIC
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2055
Practice Address - Country:US
Practice Address - Phone:908-289-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor