Provider Demographics
NPI:1386958718
Name:DR D ERIN JACOBS DC PA
Entity type:Organization
Organization Name:DR D ERIN JACOBS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHEY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-458-5251
Mailing Address - Street 1:805 W PARK AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2832
Mailing Address - Country:US
Mailing Address - Phone:662-374-5252
Mailing Address - Fax:662-453-2950
Practice Address - Street 1:805 W PARK AVE STE 5A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2832
Practice Address - Country:US
Practice Address - Phone:662-374-5252
Practice Address - Fax:662-301-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07922069Medicaid
MS428675562OtherBCBS
MS302G702325Medicare PIN