Healthcare Provider Details

I. General information

NPI: 1548498439
Provider Name (Legal Business Name): WILLIE RAY JACOBS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 RED SPRINGS RD
RED SPRINGS NC
28377-8403
US

IV. Provider business mailing address

5431 RED SPRINGS RD
RED SPRINGS NC
28377-8403
US

V. Phone/Fax

Practice location:
  • Phone: 910-733-6326
  • Fax:
Mailing address:
  • Phone: 910-733-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: