Provider Demographics
NPI:1548339260
Name:WOOLF, PAUL A (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:WOOLF
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 1:10943 W PUGET AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-2930
Mailing Address - Country:US
Mailing Address - Phone:623-974-6159
Mailing Address - Fax:602-864-0065
Practice Address - Street 1:10723 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5636
Practice Address - Country:US
Practice Address - Phone:623-848-6991
Practice Address - Fax:623-848-6993
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0232770OtherBCBS OF ARIZONA
AZAZ0232770OtherBCBS OF ARIZONA
AZ35WCHHM13Medicare ID - Type UnspecifiedMEDICARE