Provider Demographics
NPI:1619569381
Name:SCHLOSSER, JACOB M (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:M
Last Name:SCHLOSSER
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 1:1105 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2501
Mailing Address - Country:US
Mailing Address - Phone:765-664-2479
Mailing Address - Fax:765-662-1625
Practice Address - Street 1:1105 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2501
Practice Address - Country:US
Practice Address - Phone:765-664-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003203A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30058149Medicaid