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General NPI Number Information
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NPI Number | 1487782165
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Entity Type | Individual
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Provider Name | JACOB WILCOX DOM
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 1301 S SAINT FRANCIS DR STE C
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City | SANTA FE
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State | NM
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Zip | 87505-4042
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Country | US
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Telephone | 505-210-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PERIWINKLE PL
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City | SANTA FE
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State | NM
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Zip | 87508-1389
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Country | US
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Telephone | 505-210-2781
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Fax | 585-381-6188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2722
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1143
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License Number State | NM
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