Provider Demographics
NPI:1194877795
Name:JACOBS, MAX A (DC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:A
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 1:138 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3021
Mailing Address - Country:US
Mailing Address - Phone:207-774-6251
Mailing Address - Fax:207-774-6252
Practice Address - Street 1:138 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3021
Practice Address - Country:US
Practice Address - Phone:207-774-6251
Practice Address - Fax:207-774-6252
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098657OtherBCBS PROVIDER ID