Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | $$$$$$$$$ | CA |
NPI | 1134239361 |
---|---|
Provider Name | Mr. Bruce A Jacobs |
First Address | Glendale, CA 91208-1285 |
Second Address | Glendale, CA 91208-1285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/03/2011 |