Healthcare Provider Details

I. General information

NPI: 1265552178
Provider Name (Legal Business Name): WOLFF CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W MAIN ST SUITE 140
DURANT OK
74701-4558
US

IV. Provider business mailing address

3601 W MAIN ST SUITE 140
DURANT OK
74701-4558
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-3343
  • Fax: 580-931-3303
Mailing address:
  • Phone: 580-931-3343
  • Fax: 580-931-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3757
License Number StateOK

VIII. Authorized Official

Name: ROBERT WOLFF
Title or Position: OWNER
Credential: DC
Phone: 580-931-3343