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General NPI Number Information
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NPI Number | 1790585115
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Entity Type | Individual
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Provider Name | JACOB MINNICK DC
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 4106 OAKWOOD HILLS PKWY STE 200
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City | EAU CLAIRE
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State | WI
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Zip | 54701-7727
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Country | US
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Telephone | 715-203-8062
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 BUTTERFIELD RD STE 301N
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City | OAK BROOK
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State | IL
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Zip | 60523-1266
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Country | US
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Telephone | 630-468-1824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6255-12
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License Number State | WI
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