Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC-007865-L | PA |
NPI | 1114051141 |
---|---|
Provider Name | Dr. Jason Ronald Jacobs |
First Address | Vandergrift, PA 15690-0143 |
Second Address | Clarion, PA 16214-8517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JA607918 | HIGHMARK BS (01) | PA |