Deric L Jacobs, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH8698 Issued in FL

Practice address

4536 S. Clyde Morris Blvd.
Suite 3
Port Orange, FL 32129-4017

Phone

(386) 562-4099

NPI assigned

May 17, 2007

Last updated

Jan 14, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Palmer College Foundation

  dba Palmer College of Chiropractic Florida

  • Chiropractor
  • Port Orange, FL
  • NPI 1568552255
  NPD (past)
• Palmer College Foundation

  dba Palmer Chiropractic Clinic

  • Chiropractor
  • Davenport, IA
  • NPI 1174535181
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263427200000",
    "number": "1568679876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 SCOTT ST",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294225",
            "telephone_number": "386-562-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4536 S. CLYDE MORRIS BLVD.",
            "address_2": "SUITE 3",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294017",
            "telephone_number": "386-562-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "DERIC",
        "middle_name": "L",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2010-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J. Kim Periodontics, LLC
• J. Michael Panczyszyn, D.D.S., PA
• Denise Jacks, ARNP
• Jon C Jackson, M.D.
• Serenity Leilani Jackson, OTR
• Jessica Jacobsen
• Abbie Conrad James, LMHC
• Karen James
• Mary Jarvis
• Sandra Jarvis

• Chiropractor in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.