MEDICARE: MARK WOLFF, DC, LLC

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	1607	CO

General Provider Information

NPI Number	:	1457732240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK WOLFF, DC, LLC

Provider Business Mailing Address
First Line	:	215 S WADSWORTH BLVD STE 420
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1566
Country	:	US
Telephone Number	:	303-986-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S WADSWORTH BLVD STE 420
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1566
Country	:	US
Telephone Number	:	303-986-5122
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MARK WOLFF
Credential	:	D.C.
Telephone Number	:	303-985-5122

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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