Provider Demographics
NPI:1871747493
Name:JACOBS, CLINTON DRAKE (DC)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:DRAKE
Last Name:JACOBS
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:PO BOX 3709
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4019
Mailing Address - Country:US
Mailing Address - Phone:803-939-0785
Mailing Address - Fax:803-939-0787
Practice Address - Street 1:2427 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-2093
Practice Address - Country:US
Practice Address - Phone:803-939-0785
Practice Address - Fax:803-939-0787
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor