Provider Demographics
NPI:1740352046
Name:JACOBS, JEFFREY D (DC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
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 1:2940 WESTWOOD BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4120
Mailing Address - Country:US
Mailing Address - Phone:310-470-6039
Mailing Address - Fax:310-852-8133
Practice Address - Street 1:2940 WESTWOOD BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4120
Practice Address - Country:US
Practice Address - Phone:310-470-6039
Practice Address - Fax:310-852-8133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12715Medicare PIN