Healthcare Provider Details

I. General information

NPI: 1801971338
Provider Name (Legal Business Name): THADDEUS EDWARD JACOBS ND, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E SOLA ST STE 1
SANTA BARBARA CA
93101-6506
US

IV. Provider business mailing address

65 SAINT MORITZ TER
PARK CITY UT
84098-5241
US

V. Phone/Fax

Practice location:
  • Phone: 805-966-3003
  • Fax: 805-966-2990
Mailing address:
  • Phone: 805-452-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7162897-1201
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number7162897-7100
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: