MEDICARE: DR. JESSE 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	12301	TX

General Provider Information

NPI Number	:	1114356466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE JACOBS D.C.

Provider Business Mailing Address
First Line	:	9921 BEND CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7329
Country	:	US
Telephone Number	:	214-636-6906
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 HERITAGE TRACE PKWY
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8908
Country	:	US
Telephone Number	:	817-431-5100
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	06/16/2016

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