Provider Demographics
NPI:1891043063
Name:WOLF CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:WOLF CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYNEIL
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-733-4034
Mailing Address - Street 1:605 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1241
Mailing Address - Country:US
Mailing Address - Phone:515-733-4034
Mailing Address - Fax:
Practice Address - Street 1:605 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1241
Practice Address - Country:US
Practice Address - Phone:515-733-4034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05195261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
24010Medicare PIN