Individual
JACOB ROLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
34 PROFESSIONAL PKWY, TROY, MO 63379-2822
(870) 450-4918
Mailing address
34 PROFESSIONAL PKWY, TROY, MO 63379-2822
(870) 450-4918
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
2019024300
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019024300
PRIVATE INSURANCE
MO
Enumeration date
07/09/2019
Last updated
07/09/2019
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