Healthcare Provider Details

I. General information

NPI: 1720165384
Provider Name (Legal Business Name): JOEL B WULFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9678 COLORADO LANE NORTH
BROOKLYN PARK MN
55445
US

IV. Provider business mailing address

9678 COLORADO LANE NORTH
BROOKLYN PARK MN
55445
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 TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2692
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: