Provider Demographics
NPI:1285947465
Name:JACOBSON, SCOTT MICHEAL (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHEAL
Last Name:JACOBSON
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 1:3595 RANCH ROAD 620 S STE 215
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6803
Mailing Address - Country:US
Mailing Address - Phone:512-333-0055
Mailing Address - Fax:
Practice Address - Street 1:3595 RANCH ROAD 620 S STE 215
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6803
Practice Address - Country:US
Practice Address - Phone:512-333-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor