Individual
DOUGLAS EDMUND JACOBSMEYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2118 RIVERSIDE DR, STE 105, MOUNT VERNON, WA 98273-5454
(360) 424-6104
(360) 424-6009
Mailing address
2118 RIVERSIDE DR, STE 105, MOUNT VERNON, WA 98273-5454
(360) 424-6104
(360) 424-6009
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00001611
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11666
REGENCE BLUE CROSS
WA
01
—
17631
LABOR AND INDUSTRIES
WA
05
—
2088409
—
WA
Enumeration date
06/22/2005
Last updated
09/12/2007
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