Individual
MARK E JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
405 W MAIN ST, GENOA, IL 60135-1164
(815) 784-4455
(815) 784-4454
Mailing address
405 W MAIN ST, GENOA, IL 60135-1164
(815) 784-4455
(815) 784-4454
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008275
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01921720
BLUE CROSS/BLUE SHIELD IL
IL
01
—
350045727
TRICARE MEDICARE
IL
Enumeration date
07/17/2006
Last updated
08/03/2010
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