Healthcare Provider Details

I. General information

NPI: 1659519031
Provider Name (Legal Business Name): WOLFORD CHIROPRACTIC & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 EASTBROOKE COURT SUITE 130
MOUNT WASHINGTON KY
40047
US

IV. Provider business mailing address

PO BOX 1379
MOUNT WASHINGTON KY
40047-1379
US

V. Phone/Fax

Practice location:
  • Phone: 502-538-0222
  • Fax: 502-538-0282
Mailing address:
  • Phone: 502-594-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5164
License Number StateKY

VIII. Authorized Official

Name: DR. JASON RODNEY WOLFORD
Title or Position: MEMBER
Credential: D.C.
Phone: 502-594-2504