MEDICARE: DR. JOSHUA ROBERT WOLFRAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3989	OR

General Provider Information

NPI Number	:	1356671341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA ROBERT WOLFRAM D.C.

Provider Business Mailing Address
First Line	:	4356 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-689-1216
Fax Number	:	503-689-1520

Provider Business Practice Location Address
First Line	:	4356 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-383-9375
Fax Number	:	503-689-1520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	06/13/2012

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