Provider Demographics
NPI:1982084612
Name:WALDROP, JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:WALDROP
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 1:1015 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-3327
Mailing Address - Country:US
Mailing Address - Phone:256-734-5522
Mailing Address - Fax:256-737-9649
Practice Address - Street 1:1015 4TH ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3327
Practice Address - Country:US
Practice Address - Phone:256-734-5522
Practice Address - Fax:256-737-9649
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor