Provider Demographics
NPI:1629530175
Name:WOLFE, CONNOR (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:WOLFE
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 1:6771 PROFESSIONAL PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8460
Mailing Address - Country:US
Mailing Address - Phone:941-702-0553
Mailing Address - Fax:
Practice Address - Street 1:6771 PROFESSIONAL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8460
Practice Address - Country:US
Practice Address - Phone:941-702-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor