Provider Demographics
NPI:1144959891
Name:JACOBER, ZACHERY LAZAR (DC)
Entity type:Individual
Prefix:
First Name:ZACHERY
Middle Name:LAZAR
Last Name:JACOBER
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 1:1624 CLARENCE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8533
Mailing Address - Country:US
Mailing Address - Phone:262-334-4847
Mailing Address - Fax:262-334-5554
Practice Address - Street 1:1624 CLARENCE CT
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8533
Practice Address - Country:US
Practice Address - Phone:262-334-4847
Practice Address - Fax:262-334-5554
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5732-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor