Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Henricksen

Individual provider Chiropractor · NPI 1194268771

Jacob Henricksen is a Chiropractic in Lutz, Florida. Qualified in 2016, 10 years ago. Licensed in Florida.

Years since qualifying
10
Licensed in
FL
In the registry since
2016
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Practice location Address checks out

250 Crystal Grove Blvd
Lutz, FL 33548-6460
Phone: (813) 776-1480
Fax: (813) 807-4774
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Chiropractor (primary) Taxonomy 111N00000X · Licence CH14963 (FL)

Record details

NPI number1194268771
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 30, 2016
Last updated in NPPESJanuary 7, 2025
Certification dateJanuary 7, 2025
Mailing address3043 Boones Creek Rd Ste 107, Johnson City, TN 37615-4959

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCHIROPRACTIC
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Accepts Medicare assignment Not indicated

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