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General NPI Number Information
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NPI Number | 1932215498
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Entity Type | Individual
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Provider Name | KENNETH GERARD WOLF D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 1276A JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-6961
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Country | US
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Telephone | 314-707-5575
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Fax | 636-794-3012
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Provider Business Mailing Address
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Address Line | 4627 TAUNEYBROOK DR
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2219
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Country | US
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Telephone | 314-707-5575
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2006003308
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License Number State | MO
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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 | 038-009874
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License Number State | IL
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