MEDICARE: DR. JACOB HARLEY PETERSON 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	CHIR066627	GA

General Provider Information

NPI Number	:	1598614737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB HARLEY PETERSON DC

Provider Business Mailing Address
First Line	:	1055 BRADY AVE NW
Second Line	:	APT 155
City	:	ATLANTA
State	:	GA
Zip	:	30318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 N HIGHLAND AVE NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3300
Country	:	US
Telephone Number	:	404-860-1030
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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