Provider Demographics
NPI:1992824023
Name:WOLLEN, GREGORY R (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:WOLLEN
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 1:4415 S BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2611
Mailing Address - Country:US
Mailing Address - Phone:716-662-7267
Mailing Address - Fax:
Practice Address - Street 1:4407 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2611
Practice Address - Country:US
Practice Address - Phone:716-662-7267
Practice Address - Fax:716-662-2781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009972-1111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8590Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID