Healthcare Provider Details

I. General information

NPI: 1770514630
Provider Name (Legal Business Name): TODD WULF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: