Provider Demographics
NPI:1912514662
Name:JACOBSON, MEGAN ANN (DC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:SAYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:736 W RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3715
Mailing Address - Country:US
Mailing Address - Phone:852-880-9343
Mailing Address - Fax:
Practice Address - Street 1:736 W RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3715
Practice Address - Country:US
Practice Address - Phone:852-880-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12300979-1202111N00000X
ND1122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor