Healthcare Provider Details

I. General information

NPI: 1821836404
Provider Name (Legal Business Name): JACOB VOLF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 NW STATE ST
ANKENY IA
50023-1483
US

IV. Provider business mailing address

113 1ST AVE NE
BADGER IA
50516-7703
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-4594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number127348
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: