Healthcare Provider Details

I. General information

NPI: 1154485316
Provider Name (Legal Business Name): CARMEN Y JACOBY D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARMEN Y JACOBY DC

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLYVIA DR APT 3
SAINT JACOB IL
62281-1570
US

IV. Provider business mailing address

100 OLYVIA DR APT 3
SAINT JACOB IL
62281-1570
US

V. Phone/Fax

Practice location:
  • Phone: 618-927-6810
  • Fax:
Mailing address:
  • Phone: 618-927-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberH32611068907
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: