MEDICARE: JACOB EARLS

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	CHIR009620	GA

General Provider Information

NPI Number	:	1477917730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB EARLS

Provider Business Mailing Address
First Line	:	2900 LEAFWOOD DR SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5711
Country	:	US
Telephone Number	:	256-616-5260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3166 CHESTNUT DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-3206
Country	:	US
Telephone Number	:	404-419-0479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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Directions to “ JACOB EARLS ” Practice Location

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