Provider Demographics
NPI:1376517763
Name:WOLLMANN, TROY (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:WOLLMANN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6649
Mailing Address - Country:US
Mailing Address - Phone:701-223-6613
Mailing Address - Fax:701-221-9114
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-223-6613
Practice Address - Fax:701-221-9114
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17495Medicaid
ND12758OtherBCBS NUMBER
NDU38509Medicare UPIN
NDN12758Medicare ID - Type Unspecified