Provider Demographics
NPI:1639512205
Name:WOLF, TOMMY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:LEE
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 1:4180 TREAT BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1848
Mailing Address - Country:US
Mailing Address - Phone:925-759-9722
Mailing Address - Fax:
Practice Address - Street 1:4180 TREAT BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1848
Practice Address - Country:US
Practice Address - Phone:925-759-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor