Healthcare Provider Details

I. General information

NPI: 1629027164
Provider Name (Legal Business Name): ROBERT T WOLFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 ED F DAVIS RD
DURANT OK
74701-1053
US

IV. Provider business mailing address

2150 ED F DAVIS RD
DURANT OK
74701-1053
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:
Title or Position:
Credential:
Phone: