Provider Demographics
NPI:1497882872
Name:WOLF, ANTHONY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:WOLF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:CHARLES
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:410 SOUTH MITTHOEFFER ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229
Mailing Address - Country:US
Mailing Address - Phone:317-890-4026
Mailing Address - Fax:317-846-1953
Practice Address - Street 1:410 SOUTH MITTHOEFFER ROAD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229
Practice Address - Country:US
Practice Address - Phone:317-890-4026
Practice Address - Fax:317-846-1953
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100226270AMedicaid
IN100226270AMedicaid
INU20339Medicare UPIN