Provider Demographics
NPI:1912990565
Name:WOLF, JESSICA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:WOLF
Suffix:
Gender:F
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:PO BOX 815
Mailing Address - Street 2:103 WEST GLYNN DRIVE
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-0815
Mailing Address - Country:US
Mailing Address - Phone:605-928-7777
Mailing Address - Fax:605-928-1477
Practice Address - Street 1:103 WEST GLYNN DRIVE
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366
Practice Address - Country:US
Practice Address - Phone:605-928-7777
Practice Address - Fax:605-928-1477
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD253284OtherMIDLANDS CHOICE
SD4993949OtherBLUE CROSS BLUE SHIELD
SD8052OtherAVERA
SD253284OtherCIGNA
SDC999OtherDAKOTACARE
SD39012OtherSANFORD HEALTH
SD253284OtherMIDLANDS CHOICE
SD39012OtherSANFORD HEALTH