Healthcare Provider Details

I. General information

NPI: 1497290704
Provider Name (Legal Business Name): LORETTO FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607A N MILITARY ST
LORETTO TN
38469-2341
US

IV. Provider business mailing address

PO BOX 563
LORETTO TN
38469-0563
US

V. Phone/Fax

Practice location:
  • Phone: 931-306-8107
  • Fax:
Mailing address:
  • Phone: 931-306-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2984
License Number StateTN

VIII. Authorized Official

Name: DR. CHASY LYNN JACOBS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 931-306-8107