Basic Information
| Provider Information | |||||||||
| NPI: | 1639506710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | N.D., L.AC., DIPL.OM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32300 TRACY LN | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152086114 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8655 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440604170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402555508 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 66.000031 | OH | N | Other Service Providers | Acupuncturist | 175F00000X | 13-1376 | AZ | Y | Other Service Providers | Naturopath |
No ID Information.