Individual
RUSSELL STEVEN JACOBUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT(ARRT)
Contact information
Practice address
1127 OLD RD, CHAPIN, SC 29036-8512
(803) 771-0070
(803) 781-0077
Mailing address
1127 OLD RD, CHAPIN, SC 29036-8512
(803) 771-0070
(803) 781-0077
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498018
—
SC
Enumeration date
02/27/2007
Last updated
07/08/2007
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