Provider Demographics
NPI:1679284715
Name:WELKER, JACOB WELKER DAKOTA
Entity Type:Individual
Prefix:
First Name:JACOB WELKER
Middle Name:DAKOTA
Last Name:WELKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CALHOUN DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9023
Mailing Address - Country:US
Mailing Address - Phone:336-516-0637
Mailing Address - Fax:
Practice Address - Street 1:10800 HIGHWAY 707
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9700
Practice Address - Country:US
Practice Address - Phone:843-650-5600
Practice Address - Fax:843-650-2998
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT25782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer