Provider Demographics
NPI:1902960511
Name:WULF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WULF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:WULF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-782-2943
Mailing Address - Street 1:402 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4505
Mailing Address - Country:US
Mailing Address - Phone:608-782-2943
Mailing Address - Fax:609-782-2947
Practice Address - Street 1:402 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4505
Practice Address - Country:US
Practice Address - Phone:608-782-2943
Practice Address - Fax:609-782-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4102111N00000X
MN4663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38958900Medicaid
WI481967357005OtherBLUE CROSS BLUE SHEILD
MN051H2WUOtherBLUE CROSS BLUE SHIELD
WI120988OtherHEALTH PARTNERS
WI5605960001OtherMEDICAREDMEPOS
WI668981OtherACN
WI668981OtherACN
WI38958900Medicaid
WI481967357005OtherBLUE CROSS BLUE SHEILD
WI=========7OtherWPS