Basic Information
| Provider Information | |||||||||
| NPI: | 1477824357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. REENA JACOB LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2754 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600254620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472757403 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1216 AMERICAN WAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600483939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475499595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | JACOB | ||||||||
| AuthorizedOfficialFirstName: | REENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8472757403 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038.009233 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.