=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659291243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACOB KWAST CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2026
-----------------------------------------------------
Last Update Date | 07/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6745 FULTON ST E
-----------------------------------------------------
City | ADA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49301-8107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-278-8511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3071 NEWMARKET DR APT E
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49341-8976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-278-8511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JACOB MICHAEL KWAST
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 616-278-8511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------