Provider Demographics
NPI:1912415712
Name:JACOBS, KRYSTEN ALEXANDRA (DC, BSC HK)
Entity Type:Individual
Prefix:DR
First Name:KRYSTEN
Middle Name:ALEXANDRA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DC, BSC HK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8838 WALTHAM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2402
Mailing Address - Country:US
Mailing Address - Phone:410-668-4000
Mailing Address - Fax:410-668-6812
Practice Address - Street 1:1302 AMBERWOOD CIR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6755
Practice Address - Country:US
Practice Address - Phone:315-651-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03965111N00000X
TN3267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor