Healthcare Provider Details

I. General information

NPI: 1649499708
Provider Name (Legal Business Name): JOHN RONALD WULFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 NEWPORT RD
NEW LONDON NH
03256
US

IV. Provider business mailing address

PO BOX 296 391 OTTERVILLE RD.
NEW LONDON NH
03257-0296
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-7031
  • Fax: 603-526-7031
Mailing address:
  • Phone: 603-526-7031
  • Fax: 603-526-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number527-0498
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: