Provider Demographics
NPI:1730351016
Name:JACOBY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:JACOBY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-940-4342
Mailing Address - Street 1:32 E 1ST ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-3005
Mailing Address - Country:US
Mailing Address - Phone:218-940-4342
Mailing Address - Fax:
Practice Address - Street 1:32 E 1ST ST
Practice Address - Street 2:SUITE 330
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-3005
Practice Address - Country:US
Practice Address - Phone:218-940-4342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty