Provider Demographics
NPI:1215141262
Name:WOELKE, JURGEN (LAC)
Entity type:Individual
Prefix:MR
First Name:JURGEN
Middle Name:
Last Name:WOELKE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:YURGEN
Other - Middle Name:
Other - Last Name:WELKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:130 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4365
Mailing Address - Country:US
Mailing Address - Phone:707-829-5571
Mailing Address - Fax:
Practice Address - Street 1:130 S HIGH ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4365
Practice Address - Country:US
Practice Address - Phone:707-829-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACM 2974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist