Provider Demographics
NPI:1124195193
Name:WOLF, DEAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:WOLF
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 1:1813 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-2078
Mailing Address - Country:US
Mailing Address - Phone:610-374-3861
Mailing Address - Fax:610-372-8019
Practice Address - Street 1:1813 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-2078
Practice Address - Country:US
Practice Address - Phone:610-374-3861
Practice Address - Fax:610-372-8019
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004040L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU58743Medicare UPIN
PA564393Medicare ID - Type Unspecified