Provider Demographics
NPI:1043284185
Name:JACOBSON, MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PORT MALABAR BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5153
Mailing Address - Country:US
Mailing Address - Phone:321-725-7003
Mailing Address - Fax:321-725-8089
Practice Address - Street 1:1051 PORT MALABAR BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:321-725-7003
Practice Address - Fax:321-725-8089
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT95243Medicare UPIN
88860Medicare ID - Type Unspecified