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General NPI Number Information
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NPI Number | 1174737639
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Entity Type | Organization
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Legal Business Name | GEORGE I JACOB CHIROPRACTIC, INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 3516 OAKDALE RD SUITE C
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City | MODESTO
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State | CA
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Zip | 95357-0727
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Country | US
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Telephone | 209-595-5711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 578700
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City | MODESTO
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State | CA
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Zip | 95357-8700
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Country | US
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Telephone | 209-595-5711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE ISAAC JACOB
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Credential | D.C.
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Telephone | 209-595-5711
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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 | DC27611
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License Number State | CA
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