=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457732240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK WOLFF, DC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2015
-----------------------------------------------------
Last Update Date | 06/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 S WADSWORTH BLVD STE 420
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-986-5122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 S WADSWORTH BLVD STE 420
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-986-5122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. MARK WOLFF
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 303-985-5122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1607
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------