Healthcare Provider Details

I. General information

NPI: 1124156344
Provider Name (Legal Business Name): RYAN P WOLFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MAIN ST NE SUITE C
LOS LUNAS NM
87031-7409
US

IV. Provider business mailing address

1202 MAIN ST NE SUITE C
LOS LUNAS NM
87031-7409
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-1226
  • Fax: 505-480-7791
Mailing address:
  • Phone: 505-866-1226
  • Fax: 505-480-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1483
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: