Healthcare Provider Details

I. General information

NPI: 1851619357
Provider Name (Legal Business Name): WULF CLINIC HEALTHCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 HORSEBARN RD STE. 101
ROGERS AR
72758-8797
US

IV. Provider business mailing address

593 HORSEBARN RD. STE. 101
ROGERS AR
72758-8797
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD M. WULF
Title or Position: PRESIDENT
Credential: DC
Phone: 479-271-9191