Provider Demographics
NPI:1750429379
Name:JACOBS, JOAN LAURIE (DC,CDN)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:LAURIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DC,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19305 NERO AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1153
Mailing Address - Country:US
Mailing Address - Phone:718-465-1261
Mailing Address - Fax:718-740-0339
Practice Address - Street 1:19305 NERO AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1153
Practice Address - Country:US
Practice Address - Phone:718-465-1281
Practice Address - Fax:718-740-0339
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002791-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition