MEDICARE: DR. TIMOTHY L WULFERT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CE 005766	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2890	OTHER	MO	BCBS
2	253775	OTHER	MO	HEALTHLINK HMO PPO

General Provider Information

NPI Number	:	1801884630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY L WULFERT D.C.

Provider Business Mailing Address
First Line	:	PO BOX 242
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-0242
Country	:	US
Telephone Number	:	573-756-9292
Fax Number	:	573-756-9292

Provider Business Practice Location Address
First Line	:	1036 E KARSCH BLVD
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3403
Country	:	US
Telephone Number	:	573-756-9292
Fax Number	:	573-756-9292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/09/2007

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