Healthcare Provider Details

I. General information

NPI: 1730590142
Provider Name (Legal Business Name): WULFF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9422 COMMON ST UNIT 1
BATON ROUGE LA
70809-8408
US

IV. Provider business mailing address

PO BOX 14149
BATON ROUGE LA
70898-4149
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-3244
  • Fax: 225-928-3246
Mailing address:
  • Phone: 225-930-0060
  • Fax: 225-952-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1622
License Number StateLA

VIII. Authorized Official

Name: TODD JORGENSON
Title or Position: OWNER
Credential: DC
Phone: 225-928-3244