Healthcare Provider Details

I. General information

NPI: 1457732240
Provider Name (Legal Business Name): MARK WOLFF, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S WADSWORTH BLVD STE 420
LAKEWOOD CO
80226-1566
US

IV. Provider business mailing address

215 S WADSWORTH BLVD STE 420
LAKEWOOD CO
80226-1566
US

V. Phone/Fax

Practice location:
  • Phone: 303-986-5122
  • Fax:
Mailing address:
  • Phone: 303-986-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1607
License Number StateCO

VIII. Authorized Official

Name: DR. MARK WOLFF
Title or Position: MEMBER
Credential: D.C.
Phone: 303-985-5122