Provider Demographics
NPI:1205711009
Name:LASLEY, JACOB ELI (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ELI
Last Name:LASLEY
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 1:2111 VILLAGE PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4172
Mailing Address - Country:US
Mailing Address - Phone:208-944-6620
Mailing Address - Fax:
Practice Address - Street 1:2111 VILLAGE PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4172
Practice Address - Country:US
Practice Address - Phone:208-944-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14046443-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor