Healthcare Provider Details

I. General information

NPI: 1881544906
Provider Name (Legal Business Name): JACOB JOSEPH CADAC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W TWO MILE HOUSE RD
COLUMBUS IN
47201-9242
US

IV. Provider business mailing address

316 W WALNUT ST APT 113
GREENSBURG IN
47240-3418
US

V. Phone/Fax

Practice location:
  • Phone: 812-558-0574
  • Fax:
Mailing address:
  • Phone: 317-600-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC2-51581
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: