Provider Demographics
NPI:1326220120
Name:WOLPH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:WOLPH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-436-0616
Mailing Address - Street 1:640 S WINTERGARDEN RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3544
Mailing Address - Country:US
Mailing Address - Phone:419-353-6394
Mailing Address - Fax:419-354-8341
Practice Address - Street 1:640 S WINTERGARDEN RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3544
Practice Address - Country:US
Practice Address - Phone:419-353-6394
Practice Address - Fax:419-354-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2342111N00000X
OH1859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230539Medicaid
OH0888491Medicaid
OHW00724524Medicare PIN
OHU34748Medicare UPIN
OHW09279832Medicare PIN
OHV10489Medicare UPIN
OH0230539Medicaid