Provider Demographics
NPI:1578895918
Name:WOLF, LORIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LORIN
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 1:919 EARLY BLVD
Mailing Address - Street 2:STE 1C
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2209
Mailing Address - Country:US
Mailing Address - Phone:325-641-2541
Mailing Address - Fax:
Practice Address - Street 1:919 EARLY BLVD
Practice Address - Street 2:STE 1C
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2209
Practice Address - Country:US
Practice Address - Phone:325-641-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F24488Medicare PIN