Provider Demographics
NPI:1124215728
Name:WULFF CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:WULFF CHIROPRACTIC INC.
Other - Org Name:BROOKLYN PARK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:WULFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-391-9484
Mailing Address - Street 1:9678 COLORADO LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2385
Mailing Address - Country:US
Mailing Address - Phone:763-391-9484
Mailing Address - Fax:763-391-9425
Practice Address - Street 1:9678 COLORADO LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2385
Practice Address - Country:US
Practice Address - Phone:763-391-9484
Practice Address - Fax:763-391-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2692111NI0900X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C708CHOtherBCBS
MN4C708CHMedicaid