Healthcare Provider Details

I. General information

NPI: 1417986373
Provider Name (Legal Business Name): TODD M. WULF DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 HORSEBARN RD SUITE 101
ROGERS AR
72758-8760
US

IV. Provider business mailing address

PO BOX 3267
BENTONVILLE AR
72712-7713
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-9191
  • Fax: 479-271-9196
Mailing address:
  • Phone: 479-271-9191
  • Fax: 479-271-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1533
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1655
License Number StateAR

VIII. Authorized Official

Name: DR. TODD M WULF
Title or Position: OWNER
Credential: D.C.
Phone: 479-271-9191