Provider Demographics
NPI:1053542456
Name:CARTER, JACOB LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LEONARD
Last Name:CARTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 147TH ST N
Mailing Address - Street 2:PO BOX 457
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9302
Mailing Address - Country:US
Mailing Address - Phone:651-429-9010
Mailing Address - Fax:651-429-2574
Practice Address - Street 1:5673 147TH ST N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-9302
Practice Address - Country:US
Practice Address - Phone:651-429-9010
Practice Address - Fax:651-429-2574
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor