Provider Demographics
NPI:1689776460
Name:WOLF, MARY CATHERINE (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:WOLF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-2711
Mailing Address - Country:US
Mailing Address - Phone:209-634-5611
Mailing Address - Fax:209-634-9951
Practice Address - Street 1:1518 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-2711
Practice Address - Country:US
Practice Address - Phone:209-634-5611
Practice Address - Fax:209-634-9951
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC17087OtherPIN #
CAZZZ32200ZMedicare ID - Type Unspecified
DC17087OtherPIN #