MEDICARE: DR. KEVIN CHARLES JACOB DC

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	2301008846	MI

General Provider Information

NPI Number	:	1063492486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN CHARLES JACOB DC

Provider Business Mailing Address
First Line	:	3820 S LAPEER RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8751
Country	:	US
Telephone Number	:	910-678-2414
Fax Number	:	810-678-3936

Provider Business Practice Location Address
First Line	:	3820 S LAPEER RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8751
Country	:	US
Telephone Number	:	910-678-2414
Fax Number	:	810-678-3936

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	12/03/2025

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