Provider Demographics
NPI:1104065630
Name:MESECK, JACOB VICTOR (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:VICTOR
Last Name:MESECK
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 1:2199 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9010
Mailing Address - Country:US
Mailing Address - Phone:615-266-2213
Mailing Address - Fax:615-266-2365
Practice Address - Street 1:2199 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9010
Practice Address - Country:US
Practice Address - Phone:615-266-2213
Practice Address - Fax:615-266-2365
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor