Provider Demographics
NPI:1336387984
Name:VOLKMANN, JACOB (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:VOLKMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4746
Mailing Address - Country:US
Mailing Address - Phone:651-429-3500
Mailing Address - Fax:651-429-3515
Practice Address - Street 1:3634 WHITE BEAR AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4746
Practice Address - Country:US
Practice Address - Phone:651-429-3500
Practice Address - Fax:651-429-3515
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor