Healthcare Provider Details

I. General information

NPI: 1366674855
Provider Name (Legal Business Name): WULFF CHIROPRACTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 CENTRE POINTE DR
SAINT PETERS MO
63304-8579
US

IV. Provider business mailing address

71 CENTRE POINTE DR
SAINT PETERS MO
63304-8579
US

V. Phone/Fax

Practice location:
  • Phone: 636-466-1033
  • Fax:
Mailing address:
  • Phone: 636-466-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2003017105
License Number StateMO

VIII. Authorized Official

Name: DR. BRIAN WULFF
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 636-466-1033