Individual
DR. JAMIE MULANAX JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11400 158TH RD, MAYETTA, KS 66509-8866
(785) 966-8200
(785) 966-8393
Mailing address
11400 158TH RD, MAYETTA, KS 66509-8866
(785) 966-8200
(785) 966-8393
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
0105010
KS
207P00000X
Emergency Medicine Physician
05-37969
KS
207Q00000X
Family Medicine Physician
Primary
0537969
KS
207Q00000X
Family Medicine Physician
5231
OK
390200000X
Student in an Organized Health Care Education/Training Program
5231
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105010
STATE LICENSE
KS
01
—
0537969
STATE LICENSE
KS
Enumeration date
02/17/2006
Last updated
01/30/2025
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