Provider Demographics
NPI:1902926280
Name:WOLFF CHIROPRACTIC WELLNESS CENTER P.A.
Entity Type:Organization
Organization Name:WOLFF CHIROPRACTIC WELLNESS CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-552-9951
Mailing Address - Street 1:3720 WILBARGER ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3259
Mailing Address - Country:US
Mailing Address - Phone:940-552-9951
Mailing Address - Fax:940-552-2382
Practice Address - Street 1:3720 WILBARGER ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3259
Practice Address - Country:US
Practice Address - Phone:940-552-9951
Practice Address - Fax:940-552-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0013096-01Medicaid
TX40LHOtherBLUE CROSS BLUE SHIELD
TX0A3551OtherMEDICARE GROUP PTAN