Provider Demographics
NPI:1649499377
Name:JAKUBCZAK, CHARLES CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:JAKUBCZAK
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 1:5745 WENDY BAGWELL PKWY
Mailing Address - Street 2:SUITE 26
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2815
Mailing Address - Country:US
Mailing Address - Phone:678-384-1550
Mailing Address - Fax:
Practice Address - Street 1:5745 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 26
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2815
Practice Address - Country:US
Practice Address - Phone:678-384-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU86563Medicare UPIN