Provider Demographics
NPI:1528172723
Name:JAKUBOWSKI, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:JAKUBOWSKI
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 1:1923 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:740-922-9362
Practice Address - Street 1:205 GRANT ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1215
Practice Address - Country:US
Practice Address - Phone:740-922-2325
Practice Address - Fax:740-922-9362
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2617850Medicaid
OH7506718OtherAETNA
OHP00229278OtherRAILROAD MEDICARE
OH341968870027OtherCARESOURCE
OH000000368657OtherANTHEM BCBS
OH2617850Medicaid
OHP00229278OtherRAILROAD MEDICARE