Provider Demographics
NPI:1588934970
Name:GAWITH, JACOB WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WILLIAM
Last Name:GAWITH
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 1:421 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2521
Mailing Address - Country:US
Mailing Address - Phone:316-636-9393
Mailing Address - Fax:316-636-9398
Practice Address - Street 1:421 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2521
Practice Address - Country:US
Practice Address - Phone:316-636-9393
Practice Address - Fax:316-636-9398
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor