Healthcare Provider Details

I. General information

NPI: 1962344408
Provider Name (Legal Business Name): MARCO JACOBE D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16212 NORDHOFF ST
NORTH HILLS CA
91343-3806
US

IV. Provider business mailing address

6121 DARLINGTON AVE
BUENA PARK CA
90621-2448
US

V. Phone/Fax

Practice location:
  • Phone: 818-572-6570
  • Fax:
Mailing address:
  • Phone: 714-747-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: