Mark E Jacobs, D.C.
Individual provider Active NPI Chiropractor · Genoa, IL
NPI 1003834326 · NPPES record last updated Aug 3, 2010
Key facts
- NPI
- 1003834326
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038008275 (IL)
- Practice address
- 405 W Main St
Genoa, IL 60135-1164 - Phone
- (815) 784-4455
- Fax
- (815) 784-4454
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
405 W Main St
Genoa, IL 60135-1164
Phone (815) 784-4455
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101018000460 | IL | Practitioner - Chiropractic | 1052504511 | Practice locations: Genoa, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038008275 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038008275 | IL | Yes |
Addresses
Primary practice location
405 W Main St
Genoa, IL 60135-1164
Mailing address
405 W Main St
Genoa, IL 60135-1164
Phone (815) 784-4455
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350045727 | Other | IL | TRICARE MEDICARE |
| 01921720 | Other | IL | BLUE CROSS/BLUE SHIELD IL |
Other providers in Genoa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.