Provider Demographics
NPI:1780148981
Name:MCGEE, JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:MCGEE
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 1:523 1/2 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4837
Mailing Address - Country:US
Mailing Address - Phone:715-797-3099
Mailing Address - Fax:
Practice Address - Street 1:28901 S WESTERN AVE STE 225
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0824
Practice Address - Country:US
Practice Address - Phone:715-797-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty