Provider Demographics
NPI:1528125028
Name:BASTOMSKI, JACOB (DC INC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:BASTOMSKI
Suffix:
Gender:M
Credentials:DC INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2539
Mailing Address - Country:US
Mailing Address - Phone:805-569-5000
Mailing Address - Fax:805-687-7737
Practice Address - Street 1:1625 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2539
Practice Address - Country:US
Practice Address - Phone:805-569-5000
Practice Address - Fax:805-687-7737
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13450111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology