Provider Demographics
NPI:1144249418
Name:WOLTER, DENNIS E (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:E
Last Name:WOLTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-4655
Mailing Address - Country:US
Mailing Address - Phone:319-524-0905
Mailing Address - Fax:319-524-0904
Practice Address - Street 1:924 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-4655
Practice Address - Country:US
Practice Address - Phone:319-524-0905
Practice Address - Fax:319-524-0904
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05887111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA615537OtherTRIGON
IA52935OtherBC/BS
IA52935OtherBC/BS
IA615537OtherTRIGON