MEDICARE: DR. WILLIAM WARNER JACOBSON II 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
1	111N00000X	Chiropractor	DC17560	CA

General Provider Information

NPI Number	:	1578559795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM WARNER JACOBSON II D.C.

Provider Business Mailing Address
First Line	:	446 N CRAIG AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2460
Country	:	US
Telephone Number	:	626-793-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	446 N CRAIG AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2460
Country	:	US
Telephone Number	:	626-793-1633
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/21/2012

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