Healthcare Provider Details

I. General information

NPI: 1811092091
Provider Name (Legal Business Name): LANCE ALBERT WULF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N BLACK RIVER ST
SPARTA WI
54656-1529
US

IV. Provider business mailing address

601 S 32ND AVE
WAUSAU WI
54401-3958
US

V. Phone/Fax

Practice location:
  • Phone: 608-269-4511
  • Fax: 608-269-8511
Mailing address:
  • Phone: 715-848-2526
  • Fax: 715-848-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: