Healthcare Provider Details

I. General information

NPI: 1902960511
Provider Name (Legal Business Name): WULF CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SOUTH 6TH STREET
LA CROSSE WI
54601-4505
US

IV. Provider business mailing address

402 SOUTH 6TH STREET
LA CROSSE WI
54601-4505
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-2943
  • Fax: 609-782-2947
Mailing address:
  • Phone: 608-782-2943
  • Fax: 609-782-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4663
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4102
License Number StateWI

VIII. Authorized Official

Name: DR. LANCE ALBERT WULF
Title or Position: OWNER
Credential: D.C.
Phone: 608-782-2943