Individual
DERIC L JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4536 S. CLYDE MORRIS BLVD., SUITE 3, PORT ORANGE, FL 32129-4017
(386) 562-4099
Mailing address
3625 SCOTT ST, PORT ORANGE, FL 32129-4225
(386) 562-4099
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH8698
FL
Other
Enumeration date
05/17/2007
Last updated
01/14/2010
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