Provider Demographics
NPI:1841337318
Name:MEYER, JACOB DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DONALD
Last Name:MEYER
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 1:4496 MOUNT VERNON PASS
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-8238
Mailing Address - Country:US
Mailing Address - Phone:810-230-1249
Mailing Address - Fax:
Practice Address - Street 1:4496 MT VERNON PASS
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-8238
Practice Address - Country:US
Practice Address - Phone:810-230-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002054111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001746Medicaid
MI0B55021OtherBC&BS
MI1001746Medicaid
MI0M94250Medicare UPIN