MEDICARE: DR. PHILIP EDWARD WULFERT DC

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	CE 005627	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133965	OTHER	MO	HEALTHLINK
2	118699	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780671545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP EDWARD WULFERT DC

Provider Business Mailing Address
First Line	:	207 S MAIN ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1419
Country	:	US
Telephone Number	:	573-783-5530
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 S MAIN ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1419
Country	:	US
Telephone Number	:	573-783-5530
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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