Provider Demographics
NPI:1609246164
Name:WOLK, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WOLK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2427
Mailing Address - Country:US
Mailing Address - Phone:570-575-5414
Mailing Address - Fax:
Practice Address - Street 1:1810 W 25TH ST
Practice Address - Street 2:#1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3152
Practice Address - Country:US
Practice Address - Phone:570-575-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor