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General NPI Number Information
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NPI Number | 1144249418
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Entity Type | Individual
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Provider Name | DENNIS E. WOLTER D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 924 MAIN ST
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City | KEOKUK
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State | IA
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Zip | 52632-4655
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Country | US
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Telephone | 319-524-0905
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Fax | 319-524-0904
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Provider Business Mailing Address
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Address Line | 924 MAIN ST
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City | KEOKUK
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State | IA
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Zip | 52632-4655
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Country | US
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Telephone | 319-524-0905
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Fax | 319-524-0904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | A05887
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License Number State | IA
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