Provider Demographics
NPI:1548498439
Name:JACOBS, WILLIE RAY (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:RAY
Last Name:JACOBS
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 1:5431 RED SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-8403
Mailing Address - Country:US
Mailing Address - Phone:910-733-6326
Mailing Address - Fax:
Practice Address - Street 1:5431 RED SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-8403
Practice Address - Country:US
Practice Address - Phone:910-733-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2853111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner