Provider Demographics
NPI:1639506710
Name:WOLF, JACOB (ND, LAC, DIPLOM)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:ND, LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32300 TRACY LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2010
Mailing Address - Country:US
Mailing Address - Phone:215-208-6114
Mailing Address - Fax:
Practice Address - Street 1:8655 MARKET ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4170
Practice Address - Country:US
Practice Address - Phone:440-255-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH66.000031171100000X
AZ13-1376175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist