MEDICARE: CRAIG JACOBS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	F004902	TX

General Provider Information

NPI Number	:	1063456440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG JACOBS D.C.

Provider Business Mailing Address
First Line	:	5072 W PLANO PKWY
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-4476
Country	:	US
Telephone Number	:	972-267-3330
Fax Number	:	972-267-7505

Provider Business Practice Location Address
First Line	:	5072 W PLANO PKWY
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-4476
Country	:	US
Telephone Number	:	972-267-3330
Fax Number	:	972-267-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/04/2009

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Directions to “ CRAIG JACOBS D.C.” Practice Location

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