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NPI Code Detail

MEDICARE: DR. MICHAEL ANDREW JACOBSON D.C.

MEDICARE: DR. MICHAEL ANDREW 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
1111N00000XChiropractor7161AZ

General Provider Information

NPI Number : 1609966142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL ANDREW JACOBSON D.C.
Provider Business Mailing Address
First Line : 3201 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2631
Country : US
Telephone Number : 602-258-3100
Fax Number :
Provider Business Practice Location Address
First Line : 3201 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2631
Country : US
Telephone Number : 602-258-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 10/30/2015

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