Provider Demographics
NPI:1043649494
Name:SCHMUTZ, JACOB (NMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SCHMUTZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 WOOD HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1230
Mailing Address - Country:US
Mailing Address - Phone:801-425-8959
Mailing Address - Fax:
Practice Address - Street 1:2702 WOOD HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-1230
Practice Address - Country:US
Practice Address - Phone:801-425-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT88149007101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath