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General NPI Number Information
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NPI Number | 1063754943
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Entity Type | Organization
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Legal Business Name | JACOBY CHIROPRACTIC & SPORTS PERFORMANCE
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 401 W ONTARIO ST SUITE 150
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City | CHICAGO
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State | IL
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Zip | 60654-6957
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Country | US
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Telephone | 847-338-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 1735 N PAULINA ST #301
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City | CHICAGO
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State | IL
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Zip | 60622-1133
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Country | US
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Telephone | 847-338-7590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN J JACOBY
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Credential | D.C.
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Telephone | 847-338-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3801113
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License Number State | IL
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