Provider Demographics
NPI:1013156298
Name:WOLCOTT, RICHARD EARL (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:WOLCOTT
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 1:2084 COLLEGE AVE.
Mailing Address - Street 2:JOURNEY CHIROPRACTIC
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903
Mailing Address - Country:US
Mailing Address - Phone:607-733-3709
Mailing Address - Fax:607-733-3934
Practice Address - Street 1:2084 COLLEGE AVE.
Practice Address - Street 2:JOURNEY CHIROPRACTIC
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903
Practice Address - Country:US
Practice Address - Phone:607-733-3709
Practice Address - Fax:607-733-3934
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011641-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor