Healthcare Provider Details

I. General information

NPI: 1801033345
Provider Name (Legal Business Name): TAD LOUIS JACOBI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 12TH ST
BELLE PLAINE IA
52208-1753
US

IV. Provider business mailing address

732 12TH ST
BELLE PLAINE IA
52208-1753
US

V. Phone/Fax

Practice location:
  • Phone: 319-444-2555
  • Fax:
Mailing address:
  • Phone: 319-444-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007156
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: