Healthcare Provider Details

I. General information

NPI: 1639951130
Provider Name (Legal Business Name): ROBERT WILLIAM WOLFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W ELLIOT RD STE 115
GILBERT AZ
85233-5301
US

IV. Provider business mailing address

1433 W ISABELLA AVE
MESA AZ
85202-9259
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-0000
  • Fax:
Mailing address:
  • Phone: 940-473-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: