MEDICARE: JACOB FAMILY CHIROPRACTIC PLC

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
1	111N00000X	Chiropractor	2301008846	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0D41125	OTHER	MI	BCBSM
2	950D410620	OTHER	MI	BCBS PIN

General Provider Information

NPI Number	:	1225223167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB FAMILY CHIROPRACTIC PLC

Provider Business Mailing Address
First Line	:	3820 S LAPEER RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8751
Country	:	US
Telephone Number	:	810-678-2414
Fax Number	:	810-678-3936

Provider Business Practice Location Address
First Line	:	3820 S LAPEER RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8751
Country	:	US
Telephone Number	:	810-678-2414
Fax Number	:	810-678-3936

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DENISE LEE TURONEK
Credential	:
Telephone Number	:	810-678-2414

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/23/2014

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