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NPI Code Detail

MEDICARE: DR. MARTIN JACOBSON D.C.

MEDICARE: DR. MARTIN JACOBSON D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH0004008FL

General Provider Information

NPI Number : 1043284185
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARTIN JACOBSON D.C.
Provider Business Mailing Address
First Line : 1051 PORT MALABAR BLVD NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-5153
Country : US
Telephone Number : 321-725-7003
Fax Number : 321-725-8089
Provider Business Practice Location Address
First Line : 1051 PORT MALABAR BLVD NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-5153
Country : US
Telephone Number : 321-725-7003
Fax Number : 321-725-8089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/24/2007

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