Provider Demographics
NPI:1558251066
Name:ABU-AITA, JACOB A (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:A
Last Name:ABU-AITA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4001 WALLI STRASSE DR STE A
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1729
Mailing Address - Country:US
Mailing Address - Phone:810-715-7746
Mailing Address - Fax:810-715-7716
Practice Address - Street 1:4001 WALLI STRASSE DR STE A
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1729
Practice Address - Country:US
Practice Address - Phone:810-715-7746
Practice Address - Fax:810-715-7716
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor