Provider Demographics
NPI:1497811517
Name:MOOTZ, JACOB JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JAMES
Last Name:MOOTZ
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 1:5007 28TH AVE S
Mailing Address - Street 2:APT. #2
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1351
Mailing Address - Country:US
Mailing Address - Phone:651-774-7016
Mailing Address - Fax:651-774-7016
Practice Address - Street 1:951 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-4003
Practice Address - Country:US
Practice Address - Phone:651-774-7016
Practice Address - Fax:651-774-7016
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor