Provider Demographics
NPI:1568802353
Name:WOLF, DARYL (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
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 1:2742 WILLIS FOREMAN RD.
Mailing Address - Street 2:
Mailing Address - City:HEPHZABAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815
Mailing Address - Country:US
Mailing Address - Phone:229-977-6844
Mailing Address - Fax:
Practice Address - Street 1:2742 WILLIS FOREMAN RD.
Practice Address - Street 2:
Practice Address - City:HEPHZABAH
Practice Address - State:GA
Practice Address - Zip Code:30815
Practice Address - Country:US
Practice Address - Phone:229-977-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor