Provider Demographics
NPI:1992190474
Name:WOLFE CHIROPRACTIC AND FUNCTIONAL MEDICINE, INC.
Entity Type:Organization
Organization Name:WOLFE CHIROPRACTIC AND FUNCTIONAL MEDICINE, INC.
Other - Org Name:IN8 CHIROPRACIC INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-447-2225
Mailing Address - Street 1:933 ALPINE AVE.
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-447-2225
Mailing Address - Fax:303-447-2226
Practice Address - Street 1:933 ALPINE AVE.
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-447-2225
Practice Address - Fax:303-447-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005029111N00000X
COCHR0005029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1215153481OtherGROUP NPI
MD1669553756OtherINDIVIDUAL NPI
MD431PMedicare UPIN
MD431PMedicare PIN