Healthcare Provider Details

I. General information

NPI: 1891043063
Provider Name (Legal Business Name): WOLF CHIROPRACTIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 PENNSYLVANIA AVE
STORY CITY IA
50248-1241
US

IV. Provider business mailing address

605 PENNSYLVANIA AVE
STORY CITY IA
50248-1241
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-4034
  • Fax:
Mailing address:
  • Phone: 515-733-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA05195
License Number StateIA

VIII. Authorized Official

Name: RAYNEIL N WOLF
Title or Position: PRESIDENT
Credential: DC
Phone: 515-733-4034