Healthcare Provider Details

I. General information

NPI: 1124215728
Provider Name (Legal Business Name): WULFF CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9678 COLORADO LN N
BROOKLYN PARK MN
55445-2385
US

IV. Provider business mailing address

9678 COLORADO LN N
BROOKLYN PARK MN
55445-2385
US

V. Phone/Fax

Practice location:
  • Phone: 763-391-9484
  • Fax: 763-391-9425
Mailing address:
  • Phone: 763-391-9484
  • Fax: 763-391-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2692
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2692
License Number StateMN

VIII. Authorized Official

Name: DR. JOEL BRUCE WULFF
Title or Position: PRESIDENT
Credential: D.C.
Phone: 763-391-9484