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General NPI Number Information
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NPI Number | 1902960511
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Entity Type | Organization
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Legal Business Name | WULF CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 402 SOUTH 6TH STREET
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City | LA CROSSE
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State | WI
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Zip | 54601-4505
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Country | US
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Telephone | 608-782-2943
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Fax | 609-782-2947
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Provider Business Mailing Address
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Address Line | 402 SOUTH 6TH STREET
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City | LA CROSSE
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State | WI
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Zip | 54601-4505
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Country | US
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Telephone | 608-782-2943
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Fax | 609-782-2947
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANCE ALBERT WULF
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Credential | D.C.
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Telephone | 608-782-2943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4663
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4102
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License Number State | WI
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