Provider Demographics
NPI:1649441130
Name:JACOBY, BRIAN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:JACOBY
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 1:1735 N PAULINA ST APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1140
Mailing Address - Country:US
Mailing Address - Phone:847-338-7590
Mailing Address - Fax:
Practice Address - Street 1:1360 N SANDBURG TER
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2075
Practice Address - Country:US
Practice Address - Phone:773-767-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor