Provider Demographics
NPI:1114356466
Name:JACOBS, JESSE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:JACOBS
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 1:9921 BEND CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7329
Mailing Address - Country:US
Mailing Address - Phone:214-636-6906
Mailing Address - Fax:
Practice Address - Street 1:4525 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8908
Practice Address - Country:US
Practice Address - Phone:817-431-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor