Provider Demographics
NPI:1770656464
Name:WOLF, TOMMY D (DC)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:D
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 1:300 S RANCHWOOD
Mailing Address - Street 2:#19
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-354-3734
Mailing Address - Fax:405-236-0362
Practice Address - Street 1:300 S RANCHWOOD
Practice Address - Street 2:#19
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-350-1986
Practice Address - Fax:405-236-0362
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3131111N00000X
CO4784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor