Provider Demographics
NPI:1225014525
Name:JACOBS, STEVEN D (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
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 1:16 PINE ST
Mailing Address - Street 2:1
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-3141
Mailing Address - Country:US
Mailing Address - Phone:978-970-2320
Mailing Address - Fax:978-970-2320
Practice Address - Street 1:16 PINE ST
Practice Address - Street 2:1
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-3141
Practice Address - Country:US
Practice Address - Phone:978-970-2320
Practice Address - Fax:978-970-2320
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110030187BMedicaid
MA110030187BMedicaid