Provider Demographics
NPI:1821191768
Name:WOLFF, BRADLEY EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:EVAN
Last Name:WOLFF
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 1:1900 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE C1
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7024
Mailing Address - Country:US
Mailing Address - Phone:760-327-3330
Mailing Address - Fax:760-327-3486
Practice Address - Street 1:1900 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE C1
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7024
Practice Address - Country:US
Practice Address - Phone:760-327-3330
Practice Address - Fax:760-327-3486
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00050744OtherRAILROAD MEDICARE
CADC0186980Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER