Provider Demographics
NPI:1841985678
Name:JASON JAKUBAS DC PPLC
Entity type:Organization
Organization Name:JASON JAKUBAS DC PPLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:JAKUBAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-962-5468
Mailing Address - Street 1:813 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4158
Mailing Address - Country:US
Mailing Address - Phone:517-962-5468
Mailing Address - Fax:
Practice Address - Street 1:813 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4158
Practice Address - Country:US
Practice Address - Phone:517-962-5468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty