Provider Demographics
NPI:1942298534
Name:WOLK, ELLEN L (D C)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:L
Last Name:WOLK
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 MAIN ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0620
Mailing Address - Country:US
Mailing Address - Phone:781-894-4890
Mailing Address - Fax:781-894-5938
Practice Address - Street 1:751 MAIN ST
Practice Address - Street 2:SUITE 25
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0620
Practice Address - Country:US
Practice Address - Phone:781-894-4890
Practice Address - Fax:781-894-5938
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWOY36242Medicare ID - Type Unspecified