Provider Demographics
NPI:1922178664
Name:MUNSTER, WOLFGANG R (DC,PA)
Entity Type:Individual
Prefix:DR
First Name:WOLFGANG
Middle Name:R
Last Name:MUNSTER
Suffix:
Gender:M
Credentials:DC,PA
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:R
Other - Last Name:MUNSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC,PA
Mailing Address - Street 1:687 BEVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1951
Mailing Address - Country:US
Mailing Address - Phone:386-322-9800
Mailing Address - Fax:386-322-9808
Practice Address - Street 1:687 BEVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1951
Practice Address - Country:US
Practice Address - Phone:386-322-9800
Practice Address - Fax:386-322-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1672111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89367OtherBLUE CROSS BLUE SHIELD #
FL89367OtherBLUE CROSS BLUE SHIELD #