MEDICARE: JACOB ALEXANDER DEVINE 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	1374	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1374	OTHER	SD	STATE LICENSE

General Provider Information

NPI Number	:	1669076014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ALEXANDER DEVINE DC

Provider Business Mailing Address
First Line	:	5026 S MARION RD
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6701
Country	:	US
Telephone Number	:	605-759-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 S MARION RD
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6701
Country	:	US
Telephone Number	:	605-759-7779
Fax Number	:

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	06/16/2021

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