Healthcare Provider Details

I. General information

NPI: 1659676344
Provider Name (Legal Business Name): WOLFF CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W GRAND XING
MOBRIDGE SD
57601-2051
US

IV. Provider business mailing address

622 W GRAND XING
MOBRIDGE SD
57601-2051
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-5757
  • Fax:
Mailing address:
  • Phone: 605-845-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number710 SD
License Number StateSD

VIII. Authorized Official

Name: DR. JEFF LYLE WOLFF
Title or Position: OWNER
Credential: DC
Phone: 605-845-5757