Provider Demographics
NPI:1760849020
Name:WOW CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WOW CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DELF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-484-7520
Mailing Address - Street 1:758 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1539
Mailing Address - Country:US
Mailing Address - Phone:952-484-7520
Mailing Address - Fax:
Practice Address - Street 1:758 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1539
Practice Address - Country:US
Practice Address - Phone:952-484-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty